U.S. patent number 7,135,496 [Application Number 10/282,490] was granted by the patent office on 2006-11-14 for water soluble paclitaxel derivatives.
This patent grant is currently assigned to PG-TXL Company, L.P.. Invention is credited to Chun Li, Sidney Wallace, David Yang, Dong-Fang Yu.
United States Patent |
7,135,496 |
Li , et al. |
November 14, 2006 |
Water soluble paclitaxel derivatives
Abstract
Disclosed are water soluble compositions of paclitaxel and
docetaxel formed by conjugating the paclitaxel or docetaxel to a
water soluble polymer such as poly-glutamic acid, poly-aspartic
acid or poly-lysine. Also disclosed are methods of using the
compositions for treatment of tumors, auto-immune disorders such as
rheumatoid arthritis. Other embodiments include the coating of
implantable stents for prevention of restenosis.
Inventors: |
Li; Chun (Missouri City,
TX), Wallace; Sidney (Houston, TX), Yu; Dong-Fang
(Houston, TX), Yang; David (Sugar Land, TX) |
Assignee: |
PG-TXL Company, L.P. (Houston,
TX)
|
Family
ID: |
21966621 |
Appl.
No.: |
10/282,490 |
Filed: |
October 28, 2002 |
Prior Publication Data
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Document
Identifier |
Publication Date |
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US 20030073617 A1 |
Apr 17, 2003 |
|
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
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10146809 |
May 17, 2002 |
6884817 |
|
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09050662 |
Mar 30, 1998 |
6441025 |
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08815104 |
Mar 11, 1997 |
5977163 |
|
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60013184 |
Mar 12, 1996 |
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Current U.S.
Class: |
514/511;
514/449 |
Current CPC
Class: |
A61K
31/4375 (20130101); A61K 47/645 (20170801); A61K
41/0038 (20130101); A61P 35/04 (20180101); C08G
73/1092 (20130101); A61K 47/547 (20170801); A61K
31/337 (20130101); A61L 31/10 (20130101); A61K
51/065 (20130101); A61L 31/16 (20130101); A61K
51/0497 (20130101); A61K 38/13 (20130101); A61P
35/00 (20180101); A61P 35/02 (20180101); A61K
47/60 (20170801); A61K 47/59 (20170801); A61L
2300/606 (20130101); A61K 2121/00 (20130101); A61L
2300/416 (20130101); A61K 2123/00 (20130101) |
Current International
Class: |
A01N
37/00 (20060101); A61K 31/21 (20060101) |
Field of
Search: |
;514/449,510,511
;549/510,511 ;528/328 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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0569281 |
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Mar 1996 |
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EP |
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0558959 |
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Apr 1997 |
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EP |
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0604910 |
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Jun 2000 |
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EP |
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5286868 |
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Nov 1993 |
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JP |
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WO 93/10121 |
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May 1993 |
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WO |
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WO 95/03036 |
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Feb 1995 |
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WO |
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WO 95/13053 |
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May 1995 |
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WO |
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WO 96/25176 |
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Aug 1996 |
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WO |
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WO 97/33552 |
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Sep 1997 |
|
WO |
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WO 99/17804 |
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Apr 1999 |
|
WO |
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WO 99/49901 |
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Oct 1999 |
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WO |
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WO 01/70275 |
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Sep 2001 |
|
WO |
|
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|
Primary Examiner: Jones; Dameron L.
Attorney, Agent or Firm: Foley & Lardner LLP
Parent Case Text
CROSS-REFERENCE TO RELATED PATENT APPLICATIONS
This is a continuation application of U.S. application Ser. No.
10/146,809 filed May 17, 2002 now U.S. Pat. No. 6,884,817, which is
a continuation of U.S. patent application Ser. No. 09/050,662 filed
Mar. 30, 1998 (U.S. Pat. No. 6,441,025) which is a
continuation-in-part of U.S. patent application Ser. No.
08/815,104, filed Mar. 11, 1997 (U.S. Pat. No. 5,977,163), which
declares priority to U.S. Provisional Application No. 60/013,184,
filed Mar. 12, 1996, all herein incorporated by reference.
Claims
What is claimed is:
1. A composition comprising a conjugate of anticancer taxoid
therapeutic agent and a water-soluble amino acid copolymer having
50% residues or greater of a first amino acid content of that is
glutamic acid, aspartic acid and/or lysine residues and having at
least about 1% residues of a second amino acid content comprising
amino acid residues that are different than the amino acid residue
or residues of said first amino acid content, wherein said
therapeutic agent is covalently bonded to said copolymer.
2. The composition of claim 1, wherein the taxoid is paclitaxel or
taxotere.
3. The composition of claim 2, wherein the taxoid is
paclitaxel.
4. A method for making a water-soluble drug, comprising conjugating
a taxoid therapeutic agent and a water-soluble amino acid copolymer
having 50% or greater of a first amino acid content of that is
glutamic acid, aspartic acid and/or lysine residues and having at
least about 1% of a second amino acid content comprising amino acid
residues that are different than the amino acid residue or residues
of said first amino acid content, wherein said taxoid is covalently
bonded to said copolymer.
5. The method of claim 4, wherein the taxoid is paclitaxel or
taxotere.
6. The method of claim 5, wherein the taxoid is paclitaxel.
Description
FIELD OF THE INVENTION
The present invention relates generally to the fields of
pharmaceutical compositions to be used in the treatment of cancer,
autoimmune diseases and restenosis. The present invention also
relates to the field of pharmaceutical preparations of anticancer
agents such as paclitaxel (Taxol.TM.) and docetaxel (Taxotere), in
particular making paclitaxel water soluble by conjugating the drug
to water soluble moieties.
BACKGROUND OF THE INVENTION
Paclitaxel, an anti-microtubule agent extracted from the needles
and bark of the Pacific yew tree, Taxus brevifolia, has shown a
remarkable anti-neoplastic effect in human cancer in Phase I
studies and early Phase II and III trials (Horwitz et at, 1993).
This has been reported primarily in advanced ovarian and breast
cancer. Significant activity has been documented in small-cell and
non-small cell lung cancer, head and neck cancers, and in
metastatic melanoma. However, a major difficulty in the development
of paclitaxel for clinical trial use has been its insolubility in
water.
Docetaxel is semisynthetically produced from 10-deacetyl baccatin
III, a noncytotoxic precursor extracted from the needles of Taxus
baccata and esterified with a chemically synthesized side chain
(Cortes and Pazdur, 1995). Various cancer cell lines, including
breast, lung, ovarian, and colorectal cancers and melanomas have
been shown to be responsive to docetaxel. In clinical trials,
docetaxel has been used to achieve complete or partial responses in
breast, ovarian, head and neck cancers, and malignant melanoma.
Paclitaxel is typically formulated as a concentrated solution
containing paclitaxel, 6 mg per milliliter of Cremophor EL
(polyoxyethylated castor oil) and dehydrated alcohol (50% v/v) and
must be further diluted before administration (Goldspiel, 1994).
Paclitaxel (Taxol.TM.) has shown significant activity in human
cancers, including breast, ovarian, non-small cell lung, and head
and neck cancers (Rowinsky and Donehower, 1995). It has also shown
significant activity in patients with advanced breast cancer who
had been treated with multiple chemotherapeutic agents (Foa et al.,
1994). As with most chemotherapeutic agents, however, the maximum
tolerated dose of paclitaxel is limited by toxicity. In humans,
paclitaxel's major toxic effect at doses of 100 250 mg/m.sup.2 is
granulocytopenia (Holmes et al., 1995); symptomatic peripheral
neuropathy is its principal nonhematologic toxicity (Rowinsky et
al., 1993).
The amount of Cremophor EL necessary to deliver the required doses
of paclitaxel is significantly higher than that administered with
any other drug that is formulated in Cremophor. Several toxic
effects have been attributed to Cremophor, including
vasodilatation, dyspnea, and hypotension. This vehicle has also
been shown to cause serious hypersensitivity in laboratory animals
and humans (Weiss et al., 1990). In fact, the maximum dose of
paclitaxel that can be administered to mice by i.v. bolus injection
is dictated by the acute lethal toxicity of the Cremophor vehicle
(Eiseman et al., 1994). In addition, Cremophor EL, a surfactant, is
known to leach phthalate plasticizers such as
di(2-ethylhexyl)phthalate (DEHP) from the polyvinylchloride bags
and intravenous administration tubing. DEHP is known to cause
hepatotoxicity in animals and is carcinogenic in rodents. This
preparation of paclitaxel is also shown to form particulate matter
over time and thus filtration is necessary during administration
(Goldspiel, 1994). Therefore, special provisions are necessary for
the preparation and administration of paclitaxel solutions to
ensure safe drug delivery to patients, and these provisions
inevitably lead to higher costs.
Prior attempts to obtain water soluble paclitaxel have included the
preparation of prodrugs of paclitaxel by placing solubilizing
moieties such as succinate, sulfonic acid, amino acids, and
phosphate derivatives at the 2'-hydroxyl group or at the 7-hydroxyl
position (Deutsch et al., 1989; Mathew et al., Zhao and Kingston,
1991,1992; Nicolaou et al., 1993; Vyas et al., 1995, Rose et al.,
1997). While some of these prodrugs possess adequate aqueous
solubility, few have antitumor activity comparable to that of the
parent drug (Deutsch et al., 1989; Mathew et al., 1992; Rose et
al., 1997). Several of these derivatives are not suitable for i.v.
injection because of their instability in aqueous solution at
neutral pH. For example, Deutsch et al. (1989) report a
2'-succinate derivative of paclitaxel, but water solubility of the
sodium salt is only about 0.1% and the triethanolamine and
N-methylglucamine salts were soluble at only about 1%. In addition,
amino acid esters were reported to be unstable. Similar results
were reported by Mathew et al. (1992).
Recently, Nicolaou et al. (1993) reported the synthesis and in
vitro biological evaluation of a novel type of prodrug termed
"protaxols". These compounds possess greater aqueous solubility and
are converted to paclitaxel as the active drug through an
intramolecular hydrolysis mechanism. However, no in vivo data on
the antitumor activity of protaxols are yet available. Greenwald et
al. reported the synthesis of highly water-soluble 2' and
7-polyethylene glycol esters of paclitaxel (Greenwald et al.,
1994). Using the strategy of polymer linkage, others have developed
water-soluble polyethylene glycol (PEG)-conjugated paclitaxel (Li
et al., 1996; Greenwald et al., 1996). Although these conjugates
have excellent water solubility, their therapeutic efficacies are
not better than free paclitaxel. Moreover, PEG has only two
reactive functional groups at each end of its polymer chain, which
effectively limit the amount of paclitaxel that PEG could carry
(U.S. Pat. No. 5,362,831).
Other attempts to solve these problems have involved
microencapsulation of paclitaxel in both liposomes and nanospheres
(Bartoni and Boitard, 1990). The liposome formulation was reported
to be as effective as free paclitaxel, however only liposome
formulations containing less than 2% paclitaxel were physically
stable (Sharma and Straubinger, 1994). Unfortunately, the
nanosphere formulation proved to be toxic. There is still a need
therefore for a water soluble paclitaxel formulation that can
deliver effective amounts of paclitaxel and docetaxel without the
disadvantages caused by the insolubility of the drug.
Another obstacle to the widespread use of paclitaxel is the limited
resources from which paclitaxel is produced, causing paclitaxel
therapy to be expensive. A course of treatment may cost several
thousand dollars, for example. There is the added disadvantage that
not all tumors respond to paclitaxel therapy, and this may be due
to the paclitaxel not getting into the tumor. There is an immediate
need, therefore, for effective formulations of paclitaxel and
related drugs that are water soluble with long serum half lives for
treatment of tumors, autoimmune diseases such as rheumatoid
arthritis, as well as for the prevention of restenosis of vessels
subject to traumas such as angioplasty and stenting.
SUMMARY OF THE INVENTION
The present invention seeks to overcome these and other drawbacks
inherent in the prior art by providing compositions comprising a
chemotherapeutic and/or antiangiogenic drug, such as paclitaxel,
docetaxel, or other taxoid conjugated to a water soluble polymer
such as a water soluble polyamino acid, or to a water soluble metal
chelator. It is a further embodiment of the present invention that
a composition comprising a conjugate of paclitaxel and
poly-glutamic acid has surprising antitumor activity in animal
models, and further that this composition is demonstrated herein to
be a new species of taxane that has pharmaceutical properties
different from that of paclitaxel. These compositions are shown
herein to be surprisingly effective as anti-tumor agents against
exemplary tumor models, and are expected to be at least as
effective as paclitaxel, docetaxel, or other taxoid against any of
the diseases or conditions for which taxanes or taxoids are known
to be effective. The compositions of the invention provide water
soluble taxoids to overcome the drawbacks associated with the
insolubility of the drugs themselves, and also provide the
advantages of improved efficacy and controlled release so that
tumors are shown herein to be eradicated in animal models after a
single intravenous administration, as well as providing a novel
taxane. Poly-(l-glutamic acid) conjugated paclitaxel is shown in
the examples hereinbelow to have a novel drug activity, in addition
to having improved the delivery to the tumor and providing a
controlled release.
The methods described herein could also be used to make water
soluble polymer conjugates of other therapeutic agents, contrast
agents and drugs, including paclitaxel, tamoxifen, Taxotere,
etopside, teniposide, fludarabine, doxorubicin, daunomycin, emodin,
5-fluorouracil, FUDR, estradiol, camptothecin, retinoids,
verapamil, epothilones cyclosporin, and other taxoids. In
particular, those agents with a free hydroxyl group would be
conjugated to the polymers by similar chemical reactions as
described herein for paclitaxel. Such conjugation would be well
within the skill of a routine practitioner of the chemical art, and
as such would fall within the scope of the claimed invention. Those
agents would include, but would not be limited to etopside,
teniposide, camptothecin and the epothilones. As used herein,
conjugated to a water soluble polymer means the covalent bonding of
the drug to the polymer or chelator.
It is also understood that the water soluble conjugates of the
present invention may be administered in conjunction with other
drugs, including other anti-tumor or anticancer drugs. Such
combinations are known in the art. The water soluble paclitaxel,
docetaxel, or other taxoid, or in preferred embodiments the
poly-(l-glutamic) acid conjugated paclitaxel (PG-TXL), of the
present invention may, in certain types of treatment, be combined
with a platinum drug, an antitumor agent such as doxorubicin or
daunorubicin, for example, or other drugs that are used in
combination with Taxol.TM. or combined with external or internal
irradiation.
Conjugation of chemotherapeutic drugs to polymers is an attractive
approach to reduce systemic toxicity and improve the therapeutic
index. Polymers with molecular mass larger than 30 kDa do not
readily diffuse through normal capillaries and glomerular
endothelium, thus sparing normal tissue from irrelevant
drug-mediated toxicity (Maeda and Matsumura, 1989; Reynolds, 1995).
On the other hand, it is well established that malignant tumors
often have disordered capillary endothelium and greater
permeability than normal tissue vasculature (Maeda and Matsumura,
1989; Fidler et al., 1987). Tumors often lack a lymphatic
vasculature to remove large molecules that leak into the tumor
tissue (Maeda and Matsumura, 1989). Thus, a polymer-drug conjugate
that would normally remain in the vasculature may selectively leak
from blood vessels into tumors, resulting in tumor accumulation of
active therapeutic drug. The water soluble polymers, such as, in
preferred embodiments PG-TXL, may have pharmacological properties
different from non-conjugated drugs (i.e. paclitaxel).
Additionally, polymer-drug conjugates may act as drug depots for
sustained release, producing prolonged drug exposure to tumor
cells. Finally, water soluble polymers (e.g., water soluble
polyamino acids) may be used to stabilize drugs, as well as to
solubilize otherwise insoluble compounds. At present, a variety of
synthetic and natural polymers have been examined for their ability
to enhance tumor-specific drug delivery (Kopecek, 1990, Maeda and
Matsumura, 1989). However, only a few are known by the present
inventors to be currently undergoing clinical evaluation, including
SMANCS in Japan and HPMA-Dox in the United Kingdom (Maeda, 1991;
Kopecek and Kopeckova, 1993).
In the present disclosure, a taxoid is understood to mean those
compounds that include paclitaxels and docetaxel, and other
chemicals that have the taxane skeleton (Cortes and Pazdur, 1995),
and may be isolated from natural sources such as the Yew tree, or
from cell culture, or chemically synthesized molecules, and a
preferred taxane is a chemical of the general chemical formula,
C.sub.47H.sub.51 NO.sub.14, including [2aR-[2a.alpha.,4.beta.,
4.alpha..beta., 6.beta.,9.alpha.(.alpha.R,*,.beta.S*), 11.alpha.,
12.alpha., 12a.alpha.,
12b.alpha.,]]-.beta.-(Benzoylamino)-.alpha.-hydroxyben-zene
propanoic acid
6,12b,bis(acetyloxy)-12-(benzoyloxy)-2a,3,4,4a,5,6,9,10,11,12,12a,
12b-dodecahydro-4,11-dihydroxy-4a,8,13,13-tetramethyl-5-oxo-7,11-methano--
1H-cyclodeca[3,4]benz-[1,2-b]oxet-9-yl ester. It is understood that
paclitaxel and docetaxel are each more effective than the other
against certain types of tumors, and that in the practice of the
present invention, those tumors that are more susceptible to a
particular taxoid would be treated with that water soluble taxoid
or taxane conjugate.
In those embodiments in which the paclitaxel is conjugated to a
water soluble metal chelator, the composition may further comprise
a chelated metal ion. The chelated metal ion of the present
invention may be an ionic form of any one of aluminum, boron,
calcium, chromium, cobalt, copper, dysprosium, erbium, europium,
gadolinium, gallium, germanium, holmium, indium, iridium, iron,
magnesium, manganese, nickel, platinum, rhenium, rubidium,
ruthenium, samarium, sodium, technetium, thallium, tin, yttrium or
zinc. In certain preferred embodiments, the chelated metal ion will
be a radionuclide, i.e. a radioactive isotope of one of the listed
metals. Preferred radionuclides include, but are not limited to
.sup.67Ga, .sup.68Ga, .sup.111In, .sup.99mTc, .sup.90Y, .sup.114mSn
and .sup.193mPt.
Preferred water soluble chelators to be used in the practice of the
present invention include, but are not limited to,
diethylenetriaminepentaacetic acid (DTPA),
ethylenediaminetetraacetic acid (EDTA),
1,4,7,10-tetraazacyclododecane-N,N',N,''N''' tetraacetate (DOTA),
tetraazacyclotetradecane-N,N'',N'`N'`-tetraacetic acid (TETA),
hydroxyethylidene diphosphonate (HEDP), dimercaptosuccinic acid
(DMSA), diethylenetriaminetetramethylenephosphonic acid (DTTP) and
1-(p-aminobenzyl)-DTPA, 1,6-diamino hexane-N,N,N',N'-tetraacetic
acid, DPDP, and ethylenebis (oxyethylenenitrilo)-tetraacetic acid,
with DTPA being the most preferred. A preferred embodiment of the
present invention may also be a composition comprising
.sup.111In-DTPA paclitaxel, and Na-DTPA-paclitaxel.
In certain embodiments of the present invention, the paclitaxel,
docetaxel, or other taxoid may be conjugated to a water soluble
polymer, and preferably the polymer is conjugated to the 2' or the
7-hydroxyl or both of the paclitaxel, docetaxel, or other taxoid.
Poly-glutamic acid (PG) is one polymer that offers several
advantages in the present invention. First, it contains a large
number of side chain carboxyl functional groups for drug
attachment. Second, PG can be readily degraded by lysosomal enzymes
to its nontoxic basic component, l-glutamic acid, d-glutamic acid
and dl-glutamic acid. Finally, sodium glutamate has been reported
to prevent manifestations of neuropathy induced by paclitaxel, thus
enabling higher doses of paclitaxel to be tolerated (Boyle et al.,
1996). Preferred polymers include, but are not limited to
poly(l-glutamic acid), poly(d-glutamic acid), poly(dl-glutamic
acid), poly(l-aspartic acid), poly(d-aspartic acid),
poly(dl-aspartic acid), poly(l-lysine), poly(d-lysine),
poly(dl-lysine), copolymers of the above listed polyamino acids
with polyethylene glycol, polycaprolactone, polyglycolic acid and
polylactic acid, as well as poly(2-hydroxyethyl l-glutamine),
chitosan, carboxymethyl dextran, hyaluronic acid, human serum
albumin and alginic acid, with poly-glutamic acids being
particularly preferred. At the lower end of molecular weight, the
polymers of the present invention preferably have a molecular
weight of about 1,000, about 2,000, about 3,000, about 4,000, about
5,000, about 6,000, about 7,000, about 8,000, about 9,000, about
10,000, about 11,000, about 12,000, about 13,000, about 14,000,
about 15,000, about 16,000, about 17,000, about 18,000, about
19,000, about 20,000, about 21,000, about 22,000, about 23,000,
about 24,000, about 25,000, about 26,000, about 27,000, about
28,000, about 29,000, about 30,000, about 31,000, about 32,000,
about 33,000, about 34,000, about 35,000, about 36,000, about
37,000, about 38,000, about 39,000, about 40,000, about 41,000,
about 42,000, about 43,000, about 44,000, about 45,000, about
46,000, about 47,000, about 48,000, about 49,000, to about 50,000
D. At the higher end of molecular weight, the polymers of the
present invention preferably have a molecular weight of about
51,000, about 52,000, about 53,000, about 54,000, about 55,000,
about 56,000, about 57,000, about 58,000, about 59,000, about
60,000, about 61,000, about 62,000, about 63,000, about 64,000,
about 65,000, about 66,000, about 67,000, about 68,000, about
69,000, about 70,000, about 71,000, about 72,000, about 73,000,
about 74,000, about 75,000, about 76,000, about 77,000, about
78,000, about 79,000, about 80,000, about 81,000, about 82,000,
about 83,000, about 84,000, about 85,000, about 86,000, about
87,000, about 88,000, about 89,000, about 90,000, about 91,000,
about 92,000, about 93,000, about 94,000, about 95,000, about
96,000, about 97,000, about 98,000, about 99,000, to about 100,000
D. Within these ranges, the ranges of molecular weights for the
polymers are preferably of about 5,000 to about 100,000 D, with
about 20,000 to about 80,000 being preferred, or even about 25,000
to about 50,000 being more preferred.
It is a further aspect of the invention that a composition of the
invention such as PG-TXL may also be conjugated to a second
lipophilic or poorly soluble antitumor agent such as camptothecin,
epothilone, cisplatin, melphalan, Taxotere, etoposide, teniposide,
fludarabine, verapamil, or cyclosporin, for example, or even to
water soluble agents such as 5 fluorouracil (5 FU) or
fluorodeoxyuridine (FUDR), doxorubicin or daunomycin.
It is understood that the compositions of the present invention may
be dispersed in a pharmaceutically acceptable carrier solution as
described below. Such a solution would be sterile or aseptic and
may include water, buffers, isotonic agents or other ingredients
known to those of skill in the art that would cause no allergic or
other harmful reaction when administered to an animal or human
subject. Therefore, the present invention may also be described as
a pharmaceutical composition comprising a chemotherapeutic or
anti-cancer drug such as paclitaxel, docetaxel, or other taxoid
conjugated to a high molecular weight water soluble polymer or to a
chelator. The pharmaceutical composition may include polyethylene
glycol, poly-glutamic acids, poly-aspartic acids, poly-lysine, or a
chelator, preferably DTPA. It is also understood that a
radionuclide may be used as an anti-tumor agent, or drug, and that
the present pharmaceutical composition may include a therapeutic
amount of a chelated radioactive isotope.
In certain embodiments, the present invention may be described as a
method of determining the uptake of a chemotherapeutic drug such as
paclitaxel, docetaxel, or other taxoid by tumor tissue. This method
may comprise obtaining a conjugate of the drug and a metal chelator
with a chelated metal ion, contacting tumor tissue with the
composition and detecting the presence of the chelated metal ion in
the tumor tissue. The presence of the chelated metal ion in the
tumor tissue is indicative of uptake by the tumor tissue. The
chelated metal ion may be a radionuclide and the detection may be
scintigraphic. The tumor tissue may also be contained in an animal
or a human subject and the composition would then be administered
to the subject.
The present invention may also be described in certain embodiments
as a method of treating cancer in a subject. This method includes
obtaining a composition comprising a chemotherapeutic drug such as
paclitaxel, docetaxel, or other taxoid conjugated to a water
soluble polymer or chelator and dispersed in a pharmaceutically
acceptable solution and administering the solution to the subject
in an amount effective to treat the tumor. Preferred compositions
comprise paclitaxel, docetaxel, or other taxoid conjugated to a
water soluble polyamino acids, including but not limited to poly
(l-aspartic acid), poly (d-spartic acid), or poly (dl-aspartic
acid), poly (l-lysine acid), poly (d-lysine acid), or poly
(dl-lysine acid), and more preferably to poly (l-glutamic acid),
poly (d-glutamic acid, or poly (dl-glutamic acid). The compositions
of the invention are understood to be effective against any type of
cancer for which the unconjugated taxoid is shown to be effective
and would include, but not be limited to breast cancer, ovarian
cancer, malignant melanoma, lung cancer, head and neck cancer. The
compositions of the invention may also be used against gastric
cancer, prostate cancer, colon cancer, leukemia, or Kaposi's
Sarcoma. As used herein the term "treating" cancer is understood as
meaning any medical management of a subject having a tumor. The
term would encompass any inhibition of tumor growth or metastasis,
or any attempt to inhibit, slow or abrogate tumor growth or
metastasis. The method includes killing a cancer cell by
non-apoptotic as well as apoptotic mechanisms of cell death. The
method of treating a tumor may include some prediction of the
paclitaxel or docetaxel uptake in the tumor prior to administering
a therapeutic amount of the drug, by methods that include but are
not limited to bolus injection or infusion, as well as
intraarterial, intravenous, intraperitoneal, or intratumoral
administration of the drug.
This method may include any of the imaging techniques discussed
above in which a paclitaxel-chelator-chelated metal is administered
to a subject and detected in a tumor. This step provides a cost
effective way of determining that a particular tumor would not be
expected to respond to DTPA-paclitaxel therapy in those cases where
the drug does not get into the tumor. It is contemplated that if an
imaging technique can be used to predict the response to paclitaxel
and to identify patients that are not likely to respond, great
expense and crucial time may be saved for the patient. The
assumption is that if there is no reasonable amount of
chemotherapeutic agent deposited in the tumor, the probability of
tumor response to that agent is relatively small.
In certain embodiments the present invention may be described as a
method of obtaining a body image of a subject. The body image is
obtained by administering an effective amount of a radioactive
metal ion chelated to a paclitaxel-chelator conjugate to a subject
and measuring the scintigraphic signals of the radioactive metal to
obtain an image.
The present invention may also be described in certain broad
aspects as a method of decreasing at least one symptom of a
systemic autoimmune disease comprising administering to a subject,
having a systemic autoimmune disease an effective amount of a
composition comprising paclitaxel or docetaxel conjugated to
polymer, with polyamino acids being preferred and poly-glutamic
acid being more preferred. Of particular interest in the context of
the present disclosure is the treatment of rheumatoid arthritis,
which is known to respond in some cases to paclitaxel when
administered in the standard Cremophor formulation (U.S. Pat. No.
5,583,153, incorporated herein by reference). As in the treatment
of tumors, it is contemplated that the effectiveness of the water
soluble taxoids or taxane of the present invention will not be
diminished by the conjugation to a water soluble moiety. Therefore,
the compositions of the present invention are expected to be as
effective as paclitaxel against rheumatoid arthritis. Paclitaxel is
an antiangiogenic agent. Rheumatoid arthritis creates a collection
of newly formed vessels which erode the adjacent joints. It is also
understood that the taxoid or taxane compositions of the present
invention may be used in combination with other drugs, such as an
angiogenesis inhibitor (AGM-1470) (Oliver et al., 1994), or other
anti-cancer drugs, such as methotrexate.
The finding that paclitaxel also inhibits restenosis after balloon
angioplasty indicates that the water soluble paclitaxels and
docetaxels of the present invention will find a variety of
applications beyond direct parenteral administration (WO 9625176,
incorporated herein by reference). For example, it is contemplated
that water soluble paclitaxel will be useful as a coating for
implanted medical devices, such as tubings, shunts, catheters,
artificial implants, pins, electrical implants such as pacemakers,
and especially for arterial or venous stents, including
balloon-expandable stents. In these embodiments it is contemplated
that water soluble paclitaxel may be bound to an implantable
medical device, or alternatively, the water soluble paclitaxel may
be passively adsorbed to the surface of the implantable device. For
example, stents may be coated with polymer-drug conjugates by
dipping the stent in polymer-drug solution or spraying the stent
with such a solution. Suitable materials for the implantable device
should be biocompatible and nontoxic and may be chosen from the
metals such as nickel-titanium alloys, steel, or biocompatible
polymers, hydrogels, polyurethanes, polyethylenes, ethylenevinyl
acetate copolymers, etc. In a preferred embodiment the water
soluble paclitaxel, especially a PG-TXL conjugate, is coated onto a
stent for insertion into an artery or vein following balloon
angioplasty. The invention may be described therefore, in certain
broad aspects as a method of inhibiting arterial restenosis or
arterial occlusion following vascular trauma comprising
administering to a subject in need thereof, a composition
comprising paclitaxel or docetaxel conjugated to polyglutamic acid
or other water soluble poly-amino acids. In the practice of the
method, the subject may be a coronary bypass, vascular surgery,
organ transplant or coronary or any other arterial angioplasty
patient, for example, and the composition may be administered
directly, intravenously, or even coated on a stent to be implanted
at the sight of vascular trauma.
An embodiment of the invention is, therefore, an implantable
medical device, wherein the device is coated with a composition
comprising paclitaxel or docetaxel conjugated to poly-glutamic
acids or water soluble polyamino acids in an amount effective to
inhibit smooth muscle cell proliferation. A preferred device is a
stent coated with the compositions of the present invention as
described herein, and in certain preferred embodiments, the stent
is adapted to be used during or after balloon angioplasty and the
coating is effective to inhibit restenosis.
In certain preferred embodiments, the invention may be described as
a composition comprising poly-glutamic acids conjugated to the 2'
or 7 hydroxyl or both of paclitaxel, docetaxel, or other taxoids,
or even a composition comprising water soluble polyamino acids
conjugated to the 2' or 7 hydroxyl or both of paclitaxel, docetaxel
or other taxoids.
As used herein, the terms "a poly-glutamic acid" or "poly-glutamic
acids" include poly (l-glutamic acid), poly (d-glutamic acid) and
poly (dl-glutamic acid), the terms "a poly-aspartic acid" or
"poly-aspartic acids" include poly (l-aspartic acid), poly
(d-aspartic acid), poly (dl-aspartic acid), the terms "a
poly-lysine" or "poly-lysine" include poly (l-lysine), poly
(d-lysine), poly (dl-lysine), and the terms "a water soluble
polyamino acid," "water soluble polyamino acids," or "water soluble
polymer of amino acids" include, but are not limited to,
poly-glutamic acid, poly-aspartic acid, poly-lysine, and amino acid
chains comprising mixtures of glutamic acid, aspartic acid, and/or
lysine. In certain embodiments, the terms "a water soluble
polyamino acid," "water soluble polyamino acids," or "water soluble
polymer of amino acids" include amino acid chains comprising
combinations of glutamic acid and/or aspartic acid and/or lysine,
of either d and/or I isomer conformation. In certain preferred
embodiments, such a "water soluble polyamino acid" contains one or
more glutamic acid, aspartic acid, and/or lysine residues. Such
"water soluble polyamino acids" may also comprise any natural,
modified, or unusual amino acid described herein, as long as the
majority of residues, i.e. greater than 50%, comprise glutamic acid
and/or aspartic acid and/or lysine. In certain embodiments, a water
soluble polymer of amino acids that contains more than one
different type of amino acid residue is sometimes referred to
herein as a "co-polymer".
In certain embodiments, various substitutions of naturally
occurring, unusual, or chemically modified amino acids may be made
in the amino acid composition of the "water soluble polyamino
acids," and particularly in "poly-glutamic acids," to produce a
taxoid-polyamino acid conjugate of the present invention and still
obtain molecules having like or otherwise desirable characteristics
of solubility and/or therapeutic efficacy. A polyamino acid such as
poly-glutamic acid, poly-aspartic acid, poly-lysine, or water
soluble amino acids chain or polymer comprising a mixture of
glutamic acid, aspartic acid, and/or lysine, may, at the lower end
of the amino acid substitution range, have about 1, about 2, about
3, about 4, about 5, about 6, about 7, about 8, about 9, about 10,
about 12, about 13, about 14, about 15, about 16, about 17, about
18, about 19, about 20, about 21, about 22, about 23, about 24, or
about 25 or more glutamic acid, aspartic acid, or lysine, residues,
respectively, substituted by any of the naturally occurring,
modified, or unusual amino acids described herein. In other aspects
of the invention, a polyamino acid such as poly-glutamic acid,
poly-aspartic acid, poly-lysine, or a poly-amino acid chain
comprising a mixture of some or all of these three amino acids may,
at the lower end, have about 1%, about 2%, about 3%, about 4%,
about 5%, about 6%, about 7%, about 8%, about 9%, about 10%, about
11%, about 12%, about 13%, about 14%, about 15%, about 16%, about
17%, about 18%, about 19%, about 20%, about 21%, about 22%, about
23%, about 24%, to about 25% or more glutamic acid, aspartic acid,
or lysine residues, respectively, substituted by any of the
naturally occurring, modified, or unusual amino acids described
herein.
In further aspects of the invention, a polyamino acid such as
poly-glutamic acid, poly-aspartic acid, or poly-lysine may, at the
high end of the amino acid substitution range, have about 25%,
about 26%, about 27%, about 28%, about 29%, about 30%, about 31%,
about 32%, about 33%, about 34%, about 35%, about 36%, about 37%,
about 38%, about 39%, about 40%, about 41%, about 42%, about 43%,
about 44%, about 45%, about 46%, about 47%, about 48%, about 49%,
to about 50% or so of the glutamic acid, aspartic acid, or lysine
residues, respectively, substituted by any of the naturally
occurring, modified, or unusual amino acids described herein, as
long as the majority of residues comprise glutamic acid and/or
aspartic acid and/or lysine. In amino acid substitution of the
various water soluble amino acid polymers, residues with a
hydrophilicity index of +1 or more are preferred.
In certain aspects of the invention, the amount of anti-tumor drug
conjugated per water soluble polymer can vary. At the lower end,
such a composition may comprise from about 1%, about 2%, about 3%,
about 4%, about 5%, about 6%, about 7%, about 8%, about 9%, or
about 10%, about 11%, about 12%, about 13%, about 14%, about 15%,
about 16%, about 17%, about 18%, about 19%, about 20%, about 21%
about 22%, about 23%, about 24%, to about 25% (w/w) antitumor drug
relative to the mass of the conjugate. At the high end, such a
composition may comprise from about 26%, about 27%, about 28%,
about 29%, about 30%, about 31% about 32%, about 33%, about 34%,
about 35%, about 36%, about 37%, about 38%, about 39%, to about 40%
or more (w/w) antitumor drug relative to the mass of the conjugate.
Preferred anti-tumor drugs include paclitaxel, docetaxel, or other
taxoids, and preferred water soluble polymers include water soluble
amino acid polymers.
In certain other aspects of the invention, the number of molecules
of anti-tumor drug conjugated per molecule of water soluble polymer
can vary. At the lower end, such a composition may comprise from
about 1, about 2, about 3, about 4, about 5, about 6, about 7,
about 8, about 9, about 10, about 11, about 12, about 13, about 14,
about 15, about 16, about 1 7, about 18, about 19, to about 20 or
more molecules of antitumor drug per molecule of water soluble
polymer. At the higher end, such a composition may comprise from
about 21, about 22, about 23, about 24, about 25, about 26, about
27, about 28, about 29, about 30, about 31, about 32, about 33,
about 34, about 35, about 36, about 37, about 38, about 39, about
40, about 41, about 42, about 43, about 44, about 45, about 46,
about 47, about 48, about 49, about 50, about 51, about 52, about
53, about 54, about 55, about 56, about 57, about 58, about 59,
about 60 about 61, about 62, about 63, about 64, about 65, about
66, about 67, about 68, about 69, about 70, about 71, about 72,
about 73, about 74, to about 75 or more molecules or more of
antitumor drug per molecule of water soluble polymer. Preferred
anti-tumor drugs include paclitaxel, docetaxel, or other taxoids,
and preferred water soluble polymers include water soluble amino
acid polymers. The preferred number of anti-tumor drug molecules
conjugated per molecule of water soluble polymer is about 7
molecules of antitumor drug per molecule of water soluble
polymer.
Water soluble amino acid polymers with various substitutions of
residues conjugated to paclitaxel, docetaxel, or other taxoids are
referred to as "biological functional equivalents". These
"biologically functional equivalents" are part of the definition of
"water soluble polyamino acids" that are conjugated to taxoids, and
may be identified by the assays described herein as well as any
applicable assay that is known to those of skill in the art to
measure improved aqueous solubility relative to the unconjugated
taxoid or taxoids used to produce the particular water soluble
amino acid polymer-taxoid composition. In other aspects of the
invention, "biological functional equivalents" of water soluble
amino acid-taxoid polymers may be further identified by improved
anti-tumor cell activity, relative to the anti-tumor cell activity
of the unconjugated water soluble amino acid polymer used to
produce the particular water soluble amino acid polymer-taxoid
composition by the assays described herein as well as any
applicable assay that is known to those of skill in the art. The
term "biologically functional equivalents" as used herein to
describe this aspect of the invention is further described in the
detailed description of the invention.
Unless defined otherwise, all technical and scientific terms used
herein have the same meaning as commonly understood by one of
ordinary skill in the art to which this invention belongs. Also as
used herein, the term "a" is understood to include the meaning "one
or more". Although any methods and materials similar or equivalent
to those described herein can be used in the practice or testing of
the present invention, the preferred methods and materials are now
described.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
The present invention arises from the discovery of novel, water
soluble formulations of paclitaxel and docetaxel, and the
surprising efficacy of these formulations against tumor cells in
vivo. Poly (l-glutamic acid) conjugated paclitaxel (PG-TXL)
administered to mice bearing ovarian carcinoma (OCA-I) caused
significant tumor growth delay as compared to the same dose of
paclitaxel without PG. Mice treated with paclitaxel alone or with a
combination of free paclitaxel and PG showed delayed tumor growth
initially, but tumors regrew to levels comparable to an untreated
control group after ten days. Moreover, at the maximum tolerated
dose (MTD) of the PG-TXL conjugate, (160 mg equiv. paclitaxel/kg),
the growth of tumors was completely suppressed, the tumors shrank,
and mice observed for two months following treatment remained tumor
free (MTD: defined as the maximal dose that produced 15% or less
body weight loss within two wk after a single i.v. injection). In a
parallel study, the antitumor activity of PG-TXL in rats with rat
mammary adenocarcinoma (13762F) was examined. Again, complete tumor
eradication at 40 60 mg equiv. paclitaxel/kg of PG-TXL was
observed. These surprising results demonstrate that the
polymer-drug conjugate, PG-TXL, successfully eradicates well
established solid tumors in both mice and rats after a single
intravenous injection.
In addition to the remarkable antitumor (breast, ovarian, etc.)
data in syngeneic mice, good activity of PG-TXL against human
breast cancer (MDA-435) and ovarian cancer (SKOV3ip1) in nude mice
has recently been observed. Nude mice are special animals with
incomplete immune systems in which human tumors can grow.
The data presented herein have led the present inventors to
conclude that PG-TXL is a novel species of taxane that is
pharmacologically distinct from previous paclitaxel or Taxol.TM.
preparations. For example, the distribution of PG-TXL within plasma
is distinct from free paclitaxel. While paclitaxel remains in the
plasma of mice for an extremely short time, PG-TXL appears to
remain for a much longer period. This is contemplated to offer a
distinct advantage in that prolonged exposure of tumors to the drug
may result in an enhanced response. The rate of conversion of
PG-TXL to paclitaxel is slow, with less than 1% of the
radioactivity from radiolabeled PG-TXL being recovered as
radioactive paclitaxel within 48 h after injection of the
paclitaxel-polymer complex. This finding suggests that the novel
drug, PG-TXL, may produce death within tumor cells in a manner
which is not simply due to the gradual release of paclitaxel
itself.
Further evidence of the novelty of PG-TXL is that relatively high
levels of radioactivity from radiolabeled PG-TXL appear in tumor
tissue shortly after injection. However, only small amounts of
radioactivity within tumor tissue are due to the release of free
paclitaxel. Furthermore, the percent of radioactivity within tumor
tissue due to paclitaxel itself does not appreciably increase with
time suggesting again that PG-TXL is a minimal prodrug for the
gradual release of paclitaxel. Uptake of PG-TXL versus paclitaxel
has also been studied in a specialized human colon adenocarcinoma
cell transport system. While radioactivity associated with
radiolabeled PG-TXL readily gained entry into cells, only 10% of it
was due to free paclitaxel. These data parallel that which was
found in studies of tissue distribution and again suggest that
there are several mechanisms or ways in which PG-TXL may lead to
the death of cancer cells which are different from those for
paclitaxel.
In another study, it was discovered that freshly prepared PG-TXL
does not support the growth of paclitaxel-dependent cell lines
suggesting that free paclitaxel is only slowly released from the
polymer-paclitaxel complex and that the polymerpaclitaxel complex
itself is not behaving pharmacologically as "Taxol.TM.". Aging will
promote the degradation of PG-TXL and does increase the relative
ability of the resulting material to support the growth of
paclitaxel-dependent cells, but to a lesser extent than compared to
free paclitaxel.
Recent analyses of tumor tissues from mice treated with paclitaxel
suggests that, as expected, this drug results in the formation of
many apoptotic bodies within the tumor itself. Apoptosis is a
mechanism in which cells commit self-induced death or programmed
cell death, a natural process used by an organism in wound healing
and tissue remodeling. Tumors from mice treated with PG-TXL had far
fewer apoptotic bodies compared to free paclitaxel but had an
increased incidence of tumor necrosis and edema suggesting that
paclitaxel and PG-TXL may result in tumor cell death by two
distinctly different pathways.
These studies, and those described in the specific examples,
demonstrate that PG-TXL is a new taxane which is not only extremely
active against breast and ovarian cancers, and appears to have
limited side affects. It is now clear that the polymer conjugation
of paclitaxel results in a compound (PG-TXL) that has novel and
greater over-all antitumor activity.
Another aspect of the present invention is the inclusion of
molecules in the polymeric composition that are effective to target
the therapeutic composition to a disease or tumor site or to a
particular organ or tissue. Many of such targeting molecules are
known in the art and may be conjugated to the water soluble
anti-tumor compositions of the present invention. Examples of such
molecules or agents would include, but not be limited to antibodies
such as anti-tumor antibodies; anti-cell receptor antibodies;
tissue specific antibodies; hormonal agents such as octreotide,
estradiol and tamoxifen; growth factors; cell surface receptor
ligands; enzymes; hypoxic agents such as misonidazole and
erythronitroimidazole; and antiangiogenic agents.
Another composition of the present invention is DTPA-paclitaxel,
also shown herein to be as effective as paclitaxel in an in vitro
antitumor potency assay using a B16 melanoma cell line.
DTPA-paclitaxel did not show any significant difference in
antitumor effect as compared to paclitaxel against an MCa-4 mammary
tumor at a dose of 40 mg/kg body weight in a single injection.
Furthermore, .sup.111Indium labeled DTPA-paclitaxel was shown to
accumulate in the MCa-4 tumor as demonstrated by gammascintigraphy,
demonstrating that the chelator conjugated anti-tumor drugs of the
present invention are useful and effective for tumor imaging.
The novel compounds and methods of the present invention provide
significant advances over prior methods and compositions, as the
water-soluble paclitaxels are projected to improve the efficacy of
paclitaxel-based anti-cancer therapy, by providing water soluble
and controlled release paclitaxel derived compositions that also
have different antitumor properties than unmodified paclitaxel.
Such compositions eliminate the need for solvents that are
associated with side effects seen with prior paclitaxel
compositions. In addition, radiolabeled paclitaxel, which is shown
to retain anti-tumor activity, will also be useful in the imaging
of tumors. Further, the present invention allows one to determine
whether a paclitaxel will be taken up by a particular tumor by
scintigraphy, single photon emission computer tomography (SPECT) or
positron emission tomography (PET). This determination may then be
used to predict the efficacy of an anti-cancer treatment. This
information may be helpful in guiding the practitioner in the
selection of patients to undergo chelator-paclitaxel therapy.
The paclitaxel may be rendered water-soluble in many ways: i.e. by
conjugating paclitaxel to water-soluble polymers which serve as
drug carriers, and by derivatizing the antitumor drug with water
soluble chelating agents. The latter approach also provides an
opportunity for labeling with radionuclides (e.g., .sup.111In,
.sup.90Y, .sup.166Ho, .sup.68Ga, .sup.99mTc) for nuclear imaging
and/or for radiotherapy studies. The structures of paclitaxel,
polyethylene glycol-paclitaxel (PEG-paclitaxel), poly-glutamic
acid-paclitaxel conjugate (PG-TXL) and
diethylenetriaminepentaacetic acid-paclitaxel (DTPA-paclitaxel) are
shown in FIG. 1.
In certain embodiments of the present invention, DTPA-paclitaxel or
other paclitaxel-chelating agent conjugates, such as
EDTA-paclitaxel, DTTP-paclitaxel, or DOTA-paclitaxel, for example,
may be prepared in the form of water-soluble salts (sodium salt,
potassium salt, tetrabutylammonium salt, calcium salt, ferric salt,
etc.). These salts will be useful as therapeutic agents for tumor
treatment. Secondly, DTPA-paclitaxel or other paclitaxel-chelating
agents will be useful as diagnostic agents which when labeled with
radionuclides such as .sup.111In or .sup.99mTc, may be used as
radiotracers to detect certain tumors in combination with nuclear
imaging techniques. It is understood that in addition to paclitaxel
(Taxol.TM.) and docetaxel (Taxotere), other taxane derivatives may
be adapted for use in the compositions and methods of the present
invention and that all such compositions and methods would be
encompassed by the present invention.
As modifications and changes may be made in the structure of the
water soluble polymer such as a water soluble polyamino acid, or a
water soluble metal chelator, of the present invention and still
obtain molecules having like or otherwise desirable
characteristics, such "biologically functional equivalents" or
"functional equivalents" are also encompassed within the present
invention.
For example, one of skill in the art will recognize that certain
amino acids may be substituted for other amino acids in a polyamino
acid structure, including water soluble amino acid polymers such as
poly-glutamic acid, poly-aspartic acid, or poly-lysine, without
appreciable loss of interactive binding capacity with structures
such as, for example, a chemotherapeutic and/or antiangiogenic
drug, such as paclitaxel or docetaxel, or such like. Additionally,
amino acid substitutions in a water soluble polyamino acid
conjugated to a chemotherapeutic and/or antiangiogenic drug, such
as paclitaxel or docetaxel, or such like, as exemplified by but not
limited to PG-TXL, may be made and still maintain part or all of
the novel pharmacological properties disclosed herein. Since it is
the interactive capacity and nature of a protein that defines that
protein's biological functional activity, certain amino acid
sequence substitutions can be made in a polyamino acid sequence and
nevertheless obtain a polyamino acid with like (agonistic)
properties. It is thus contemplated by the inventors that various
changes may be made in the sequence of the water soluble polyamino
acids of a drug conjugate, such as, but not limited to PG-TXL,
without appreciable loss of their biological utility or
activity.
In terms of functional equivalents, it is well understood by the
skilled artisan that, inherent in the definition of a "biologically
functional equivalent of a water soluble polyamino acid," is the
concept that there is a limit to the number of changes that may be
made within a portion of the molecule and still result in a
molecule with an acceptable level of equivalent biological
activity. Biologically functional equivalent of a water soluble
polyamino acids, are thus defined herein as those water soluble
polyamino acids in which certain, not most or all, of the amino
acids may be substituted by non-water soluble amino acids, whether
natural, unusual, or chemically modified.
In particular, where shorter length water soluble polyamino acids
are concerned, it is contemplated that fewer amino acids should be
made within the given peptide. Longer domains may have an
intermediate number of changes. The longest water soluble polyamino
acid chains, as described herein, will have the most tolerance for
a larger number of changes. Of course, a plurality of distinct
water soluble polyamino acids, such as but not limited to poly
glutamic acid, poly aspartic acid, or poly-lysine, with different
substitutions may easily be made and used in accordance with the
invention.
It is also well understood that where certain residues are shown to
be particularly important to the biological or structural
properties of a polyamino acid, such residues may not generally be
exchanged. In this manner, functional equivalents are defined
herein as those water soluble polyamino acids which maintain a
substantial amount of their native biological activity.
Amino acid substitutions are generally based on the relative
similarity of the amino acid side-chain substituents, for example,
their hydrophobicity, hydrophilicity, charge, size, and the like.
An analysis of the size, shape and type of the amino acid sidechain
substituents reveals that arginine, lysine and histidine are all
positively charged residues; that alanine, glycine and serine are
all a similar size; and that phenylalanine, tryptophan and tyrosine
all have a generally similar shape. Therefore, based upon these
considerations, arginine, lysine and histidine; alanine, glycine
and serine; and phenylalanine, tryptophan and tyrosine; are defined
herein as biologically functional equivalents.
To effect more quantitative changes, the hydropathic index of amino
acids may be considered. Each amino acid has been assigned a
hydropathic index on the basis of their hydrophobicity and charge
characteristics, these are: isoleucine (+4.5); valine (+4.2);
leucine (+3.8); phenylalanine (+2.8); cysteine/cystine (+2.5);
methionine (+1.9); alanine (+1.8); glycine (-0.4); threonine
(-0.7); serine (-0.8); tryptophan (-0.9); tyrosine (-1.3); proline
(-1.6); histidine (-3.2); glutamate (-3.5); glutamine (-3.5);
aspartate (-3.5); asparagine (-3.5); lysine (-3.9); and arginine
(-4.5).
The importance of the hydropathic amino acid index in conferring
interactive biological function on a protein, and correspondingly a
polyamino acid, is generally understood in the art (Kyte &
Doolittle, 1982, incorporated herein by reference). It is known
that certain amino acids may be substituted for other amino acids
having a similar hydropathic index or score and still retain a
similar biological activity. In making changes based upon the
hydropathic index, the substitution of amino acids whose
hydropathic indices are within .+-.2 is preferred, those which are
within .+-.1 are particularly preferred, and those within .+-.0.5
are even more particularly preferred.
It is also understood in the art that the substitution of like
amino acids can be made effectively on the basis of hydrophilicity.
As detailed in U.S. Pat. No. 4,554,101, the following
hydrophilicity values have been assigned to amino acid residues:
arginine (+3.0); lysine (+3.0); aspartate (+3.0.+-.1); glutamate
(+3.0.+-.1); serine (+0.3); asparagine (+0.2); glutamine (+0.2);
glycine (0); threonine (-0.4); proline (-0.5.+-.1); alanine (-0.5);
histidine (-0.5); cysteine (-1.0); methionine (-1.3); valine
(-1.5); leucine (-1.8); isoleucine (-1.8); tyrosine (-2.3);
phenylalanine (-2.5); tryptophan (-3.4). In making changes based
upon similar hydrophilicity values, the substitution of amino acids
whose hydrophilicity values are within .+-.2 is preferred, those
which are within .+-.1 are particularly preferred, and those within
.+-.0.5 are even more particularly preferred. Hence, in reference
to hydrophilicity, arginine, iysine, aspartic acid, and glutamic
acid are defined herein as biologically functional equivalents,
particularly in water soluble amino acid polymers.
In addition to the water soluble polyamino acid-chemotherapeutic
and/or antiangiogenic drug compounds described herein, such as
paclitaxel or docetaxel conjugated to a water soluble amino acid,
or such like, as exemplified by, but not limited to PG-TXL
compounds described herein, the inventors also contemplate that
other sterically similar compounds may be formulated to mimic the
key portions of the water soluble polyamirlo acid structure. Such
compounds, which may be termed peptidomimetics, may be used in the
same manner as the peptides of the invention and hence are also
functional equivalents.
Certain mimetics that mimic elements of protein secondary structure
are described in Johnson et al. (1993). The underlying rationale
behind the use of peptide mimetics is that the peptide backbone of
proteins, including polyamino acids, exists chiefly to orientate
amino acid side chains in such a way as to facilitate molecular
interactions, such as those of antibody and antigen. A peptide
mimetic is thus designed to permit molecular interactions similar
to the natural molecule.
Some successful applications of the peptide mimetic concept have
focused on mimetics of .beta.-turns within proteins, which are
known to be highly antigenic. Likely .beta.-turn structure within a
polypeptide can be predicted by computer-based algorithms, as
discussed herein. Once the component amino acids of the turn are
determined, mimetics can be constructed to achieve a similar
spatial orientation of the essential elements of the amino acid
side chains.
The generation of further structural equivalents or mimetics may be
achieved by the techniques of modeling and chemical design known to
those of skill in the art. The art of receptor modeling is now well
known, and by such methods a chemical that binds to water soluble
polyamino acids can be designed and then synthesized. It will be
understood that all such sterically designed constructs fall within
the scope of the present invention.
In addition to the 20 "standard" amino acids provided through the
genetic code, modified or unusual amino acids are also contemplated
for use in the present invention. A table of exemplary, but not
limiting, modified or unusual amino acids is provided herein
below.
TABLE-US-00001 TABLE 1 Modified and Unusual Amino Acids Abbr. Amino
Acid Abbr. Amino Acid Aad 2-Aminoadipic acid EtAsn
N-Ethylasparagine bAad 3-Aminoadipic acid Hyl Hydroxylysine bAla
beta-alanine, beta-Amino-propionic aHyl allo-Hydroxylysine acid Abu
2-Aminobutyric acid 3Hyp 3-Hydroxyproline 4Abu 4-Aminobutyric acid,
piperidinic 4Hyp 4-Hydroxyproline acid Acp 6-Aminocaproic acid Ide
Isodesmosine Ahe 2-Aminoheptanoic acid alle allo-Isoleucine Aib
2-Aminoisobutyric acid MeGly N-Methylglycine, sarcosine bAib
3-Aminoisobutyric acid Melle N-Methylisoleucine Apm 2-Aminopimelic
acid MeLys 6-N-Methyllysine Dbu 2,4-Diaminobutyric acid MeVal
N-Methylvaline Des Desmosine Nva Norvaline Dpm 2,2'-Diaminopimelic
acid Nle Norleucine Dpr 2,3-Diaminopropionic acid Orn Ornithine
EtGly N-Ethylglycine --
Toxicity studies, pharmacokinetics and tissue distribution of
DTPA-paclitaxel have shown that in mice the LD50 (50% lethal dose)
of DPTA-paclitaxel observed with a single dose intravenous (iv)
injection is about 110 mg/kg body weight. Direct comparison with
paclitaxel is difficult to make because of the dose-volume
constraints imposed by limited solubility of paclitaxel and vehicle
toxicity associated with iv administration. However, in light of
the present disclosure, one skilled in the art of chemotherapy
would determine the effective and maximum tolerated doses (MTD) in
a clinical study for use in human subjects.
In certain embodiments of the invention, a stent coated with the
polymerpaclitaxel conjugates may be used to prevent restenosis, the
closure of arteries following balloon angioplasty. Recent results
in clinical trials using balloon-expandable stents in coronary
angioplasty have shown a significant benefit in patency and the
reduction of restenosis compared to standard balloon angioplasty
(Serruys et al., 1994). According to the response-to-injury
hypothesis, neointima formation is associated with increased cell
proliferation. Currently, popular opinion holds that the critical
process leading to vascular lesions in both spontaneous and
accelerated atherosclerosis is smooth muscle cell (SMC)
proliferation (Phillips-Hughes and Kandarpa, 1996). Since SMC
phenotypic proliferation after arterial injury mimics that of
neoplastic cells, it is possible that anticancer drugs may be
useful to prevent neointimal SMC accumulation. Stents coated with
polymer-linked anti-proliferative agents that are capable of
releasing these agents over a prolonged period of time with
sufficient concentration will thus prevent ingrowth of hyperplastic
intima and media into the lumen thereby reducing restenosis.
Because paclitaxel has been shown to suppress collagen induced
arthritis in a mouse model (Oliver et al. 1994), the formulations
of the present invention are also contemplated to be useful in the
treatment of autoimmune and/or inflammatory diseases such as
rheumatoid arthritis. Paclitaxel binding to tubulin shifts the
equilibrium to stable microtubule polymers and makes this drug a
strong inhibitor of eukaryotic cell replication by blocking cells
in the late G2 mitotic stage. Several mechanisms may be involved in
arthritis suppression by paclitaxel. For example, paclitaxel's
phase specific cytotoxic effects may affect rapidly proliferating
inflammatory cells, and furthermore paclitaxel inhibits cell
mitosis, migration, chemotaxis, intracellular transport and
neutrophil H.sub.2O.sub.2 production. In addition, paclitaxel may
have antiangiogenic activity by blocking coordinated endothelial
cell migration (Oliver et al. 1994). Therefore, the water soluble
polyamino acids conjugated paclitaxel of the present invention are
contemplated to be useful in the treatment of rheumatoid arthritis.
The polymer conjugated formulation disclosed herein would also
offer the advantages of controlled release of the drug and greater
solubility. It is also an aspect of the treatment of arthritis that
the formulations may be injected or implanted directly into the
affected joint areas.
The pharmaceutical preparations of paclitaxel or docetaxel suitable
for injectable use include sterile aqueous solutions or dispersions
and sterile powders for the preparation of sterile injectable
solutions or dispersions. In all cases the form must be sterile and
must be fluid for injection. It must be stable under the conditions
of manufacture and storage and must be preserved against the
contaminating action of microorganisms, such as bacteria and fungi.
The carrier may be a solvent or dispersion medium containing, for
example, water, ethanol, polyol (for example, glycerol, propylene
glycol and liquid polyethylene glycol, and the like), suitable
mixtures thereof, and vegetable oils. The prevention of the action
of microorganisms can be brought about by various antibacterial and
antifungal agents, for example, parabens, chlorobutanol, phenol,
sorbic acid, thimerosal, and the like. In many cases, it will be
preferable to include isotonic agents, for example, sugars or
sodium chloride.
Sterile injectable solutions are prepared by incorporating the
active compounds in the required amount in the appropriate solvent
with various of the other ingredients enumerated above, as
required, followed by filtered sterilization. Generally,
dispersions are prepared by incorporating the various sterilized
active ingredients into a sterile vehicle which contains the basic
dispersion medium and the required other ingredients from those
enumerated above. In the case of sterile powders for the
preparation of sterile injectable solutions, the preferred methods
of preparation are vacuum-drying and freeze-drying techniques which
yield a powder of the active ingredient plus any additional desired
ingredient from a previously sterile-filtered solution thereof.
As used herein, "pharmaceutically acceptable carrier" includes any
and all solvents, dispersion media, coatings, antibacterial and
antifungal agents and isotonic agents and the like. The use of such
media and agents for pharmaceutically active substances is well
known in the art. Except insofar as any conventional media or agent
is incompatible with the active ingredient, its use in the
therapeutic compositions is contemplated. Supplementary active
ingredients can also be incorporated into the compositions.
The phrase "pharmaceutically acceptable" also refers to molecular
entities and compositions that do not produce an allergic or
similar untoward reaction when administered to an animal or a
human.
For parenteral administration in an aqueous solution, for example,
the solution should be suitably buffered if necessary and the
liquid diluent first rendered isotonic with sufficient saline or
glucose. These particular aqueous solutions are especially suitable
for intravenous and intraperitoneal administration. In this
connection, sterile aqueous media which can be employed will be
known to those of skill in the art in light of the present
disclosure.
The following examples are included to demonstrate preferred
embodiments of the invention. It should be appreciated by those of
skill in the art that the techniques disclosed in the examples
which follow represent techniques discovered by the inventor to
function well in the practice of the invention, and thus can be
considered to constitute preferred modes for its practice. However,
those of skill in the art should, in light of the present
disclosure, appreciate that many changes can be made in the
specific embodiments which are disclosed and still obtain a like or
similar result without departing from the spirit and scope of the
invention.
EXAMPLE 1
Poly-Glutamic Acid-Paclitaxel (PG-TXL)
The present example concerns a first study involving the
conjugation of paclitaxel to a water-soluble polymer, poly
(l-glutamic acid) (PG) and the efficacy of the preparation against
a variety of tumors in mice and rats. The potential of
water-soluble polymers used as drug carriers is well established
(Kopecek, 1990; Maeda and Matsumura, 1989).
Synthesis of Poly-Glutamic Acid-Paclitaxel (PG-TXL)
PG was selected as a carrier for paclitaxel because it can be
readily degraded by lysosomal enzymes, is stable in plasma and
contains sufficient functional groups for drug attachment. Several
antitumor drugs, including Adriamycin (Van Heeswijk et al., 1985;
Hoes et al., 1985), cyclophosphamide (Hirano et al., 1979), Ara-C
(Kato et al., 1984) and melphalan (Morimoto et al., 1984) have been
conjugated to PG. However, poly-aspartic acid may be conjugated to
anti-tumor drugs using the reaction scheme described herein for
PG-TXL.
The reaction scheme is presented in FIG. 1B. Poly(l-glutamic acid)
(PG) sodium salt was obtained from Sigma (St. Louis, Mo.). The
polymer by viscosity had a molecular weight of 36,200, and
number-average molecular weight (Mn) of 24,000 as determined by
low-angle laser light scattering (LALLS). Lot-specific
polydispersity (M.sub.w/M.sub.n) was 1.15 where Mwis weight-average
molecular weight. PG sodium salt (MW 34 K, Sigma, 0.35 g) was first
convened to PG in its proton form. The pH of the aqueous PG sodium
salt solution was adjusted to 2.0 using 0.2 M HCl. The precipitate
was collected, dialyzed against distilled water, and lyophilized to
yield 0.29 g PG.
To a solution of PG (75 mg, repeating unit FW 170, 0.44 mmol) in
dry N,N-dimethylformamide (DMF) (1.5 mL) was added 22 mg paclitaxel
(0.026 mmol, molar ratio PG/paclitaxel=17), 15 mg
dicyclohexylcarbodiimide (DCC) (0.073 mmol) and trace amount of
dimethylaminopyridine (DMAP). Paclitaxel was supplied by Hande Tech
(Houston, Tex.), and the purity was 99% and higher as confirmed by
HPLC assay.
The reaction was allowed to proceed at room temperature for 12 18
h. Thin layer chromatography (TLC, silica) showed complete
conversion of paclitaxel (Rf=0.55) to polymer conjugate (Rf=O,
CHCl.sub.3/MeOH=10:1). To stop the reaction, the mixture was poured
into chloroform. The resulting precipitate was collected and dried
in vacuum to yield 70 mg polymer-drug conjugate. By changing the
weight ratio of paclitaxel to PG in the starting materials,
polymeric conjugates of various paclitaxel concentrations can be
synthesized.
The sodium salt of PG-TXL conjugate was obtained by dissolving the
product in 1.0 M NaHCO3. The aqueous solution of PG-TXL was
dialyzed against distilled water (MWCO 10,000) to remove low
molecular weight contaminants and excess NaHCO3 salt.
Lyophilization of the dialysate yielded 98 mg of product as a white
powder. The paclitaxel content in this polymeric conjugate as
determined by UV was 20 22% (w/w). Yield: 98% (conversion to
polymer bound paclitaxel, UV). Solubility in water>20 mg
paclitaxel/ml. A similar method can be used to synthesize PG-TXL
with higher paclitaxel content (up to 35%) by simply increasing the
ratio of paclitaxel to PG used.
Characterization of Poly-Glutamic Acid-Paclitaxel (PG-TXL)
Ultraviolet spectra were obtained on a Beckman DU-70
spectrophotometer, using the same concentration of PG aqueous
solution as reference. PG-TXL showed characteristic paclitaxel
absorption with Amax shifts from 228 to 230 nm. The concentration
of paclitaxel in PG-TXL conjugate was estimated based on standard
curve generated with known concentrations of paclitaxel in methanol
at absorption of 228 nm assuming that the polymer conjugate in
water at 230 nm and the free drug in methanol at 228 nm have the
same molar extinction and both follow Lambert Beer's law.
.sup.1H-NMR spectra were recorded with GE model GN 500 (500 MHz)
spectrometer in D.sub.2O. Both the PG moieties and the paclitaxel
moieties were discernible. The couplings of polymer conjugated
paclitaxel are too poorly resolved to be measured with sufficient
accuracy. Resonances at 7.75 to 7.36 ppm are attributable to
aromatic components of paclitaxel resonances at 6.38 ppm
(C.sub.10--H), 5.97 ppm (C.sub.13--H), 5.63 ppm (C.sub.2'--H, d),
5.55 5.36 ppm (C.sub.3'--H and C.sub.2--H, m), 5.10 ppm
(C.sub.5--H), 4.39 ppm (C.sub.7--H), 4.10 (C.sub.20--H), 1.97 ppm
(OCOCH.sub.3), and 1.18 1.20 ppm (C CH.sub.3) are tentatively
assigned to aliphatic components of paclitaxel. Other resonances
were obscured by the resonances of PG. PG resonances at 4.27 ppm
(H-.alpha.), 2.21 ppm (H-.gamma.), and 2.04 ppm (H-.beta.) are in
accordance with pure PG spectrum. Although a peak at 5.63 ppm could
be tentatively assigned to the C-2' proton of the C-2' ester, the
C-2' proton of unsubstituted paclitaxel at 4.78 ppm was also
present, suggesting that the resulting conjugate may contain
paclitaxel substitutions at both the C-2' and C-7 positions. A 100
mg/ml solution of the conjugate produces a clear, viscous, yet
flowable liquid. This procedure consistently produces PG-TXL
conjugate containing 20% of paclitaxel by weight, i.e.,
approximately 7 paclitaxel molecules are bound to each polymer
chain.
Gel Permeation Chromatography Studies of Poly-Glutamic
Acid-Paclitaxel (PGTXL)
The relative molecular weight of PG-TXL was characterized by gel
permeation chromatography (GPC). The GPC system consisted of two
LDC model III pumps coupled with LDC gradient master, a PL gel GPC
column, and a Waters 990 photodiode array detector. The elutant
(DMF) was run at I 0.0 ml/min with ultraviolet (UV) detection set
at 270 nm. For PG-TXL sodium salt, a TSK-gel column suitable for
analysis of water-soluble polymer was used, and the system was
eluted with 0.2 mM PBS (pH 6.8) at 1.0 ml/min. Conjugation of
paclitaxel to PG resulted in an increase in the molecular weight of
PG-TXL, as indicated by the shift of retention time from 6.4 min
for PG to 5.0 min for PG-TXL conjugate. The crude product contained
small molecular weight contaminants (retention time 8.0 to 10.0
min, and 11.3 min), which can be effectively removed by convening
PG-TXL to its sodium salt, followed by dialysis.
Hydrolytic Degradation of a Poly-Glutamic Acid-Paclitaxel (PG-TXL)
Conjugate
To gain insight on the release kinetics of paclitaxel and related
molecular species from PG-TXL, the hydrolytic stability of PG-TXL
was tested in PBS at various pH. High performance liquid
chromatography (HPLC) revealed that incubation of PG-TXL in PBS
solutions produced paclitaxel and several other species including
one that is more hydrophobic than paclitaxel (metabolite 1). The
fact that these species all were derived from paclitaxel was
confirmed through similar degradation studies using
PG-[.sup.3H]TXL. Based on its retention time on HPLC, metabolite-1
is probably 7-epipaclitaxel, a biologically active isomer of
paclitaxel. In fact, the amount of metabolite 1 recovered in PBS
surpassed that of paclitaxel after 5 days and 1 day of incubation
at pH 7.4 and pH 9.5 respectively (FIG. 6). At pH 5.5 and pH 7.4,
the release profiles of metabolite 1 indicated pseudo-zero order
kinetics and displayed a delay time varying from 3 days (pH 5.5) to
7 h (pH 7.4), suggesting that metabolite-1 is a secondary product.
Apparently, PG-TXL is more stable in acidic solution than in basic
solution.
In vivo Antitumor Activity
All animal work was carried out at the animal facility at M.D.
Anderson Cancer Center in accordance with institutional guidelines.
C3H/Kam mice were bred and maintained in a pathogen-free facility
in the Department of Experimental Radiation Oncology.
The tumor growth delay induced by PG-TXL was measured in mammary
ovarian carcinoma (OCA-1) implanted in C3Hf/Kam mice. All tumors
were syngeneic to this strain. Solitary tumors were produced in the
muscle of the right thigh of female C3H/Kam mice (25 30 g) by
injecting 5.times.10.sup.5 murine ovarian carcinoma cells (OCA-1),
mammary carcinoma (MCa-4), hepatocarcinoma (HCa-I) or fibrous
sarcoma (FSa-II). In a parallel study, female Fischer 344 rats (125
150 g) were injected with 1.0.times.10.sup.5 viable 13762F tumor
cells in 0.1 ml PBS. Treatments were initiated when the tumors in
mice had grown to 500 mm.sup.3 (10 mm in diameter), or when the
tumors in rats had grown to 2400 mm.sup.3 (mean diameter 17
mm).
PG-TXL was disolved in saline (10 mg equivalent paclitaxel/ml), and
paclitaxel was dissolved in Cremophor EL.RTM. vehicle (6 mg/ml).
Data are presented as mean.+-.standard deviation of tumor volumes.
In control studies, saline (0.6 ml), Cremophor vehicle [50/50
Cremophor/ethanol diluted with saline (1:4)], PG solution in
saline, and paclitaxel plus PG were used. The maximum tolerated
dose (MTD) of PG-TXL and paclitaxel in normal female C3HtYKam mice
was estimated to be 160 mg/kg and 80 mg/kg respectively. A single
dose of PG-TXL in saline or paclitaxel in Cremophor EL vehicle was
given in doses varying from 40 to 160 mg equiv. Paclitaxel/kg body
weight. Tumor growth was determined daily (FIGS. 7A, 7B, 7C, 7D and
7E) by measuring three orthogonal tumor diameters. Tumor volume was
calculated according to formula (A.times.B.times.C)/2. Absolute
growth delay (AGD) in mice is defined as the time in days for
tumors treated with various drugs to grow from 500 to 2,000
mm.sup.3 in mice minus the time in days for tumors treated with
saline control to grow from 500 to 2,000 mm.sup.3. When the tumor
size reached 2000 mm.sup.3, the tumor growth delay was calculated;
the mice were sacrificed when tumors were approximately 2500
mm.sup.3. The PG-TXL group were (n=6 and 7), other each group were
(n=5). Table 2 summarizes acute toxicity of PG paclitaxel in rats
in comparison with paclitaxel/Cremophor. Table 3 summarizes the
data concerning the effect of PG-TXL against MCa-4, FSa-II and
HCa-I tumors in mice. The data are also summarized in FIG. 7A FIG.
7E.
TABLE-US-00002 TABLE 2 Acute Toxicity of PG-TXL in Fischer Rats*
#of Time of Full Dose Toxic Body Weight Time at Nadir Recovery
Group (mg/kg) Death Loss in % (days) (days) PG-TXL.sup.a 60 1/4
15.7 7 14 PG-TXL.sup.a 40 0/4 11.1 6 11 Paclitaxel.sup.b 60 1/4
16.7 6 15 Paclitaxel.sup.b 40 0/3 17.9 6 16 Paclitaxel.sup.b 20 0/5
17.0 5 N/A *Drugs were administered intravenously into 13762F
tumor-bearing Fischer rats (female, 130 g) in a single injection.
.sup.aPG-TXL solution was prepared by dissolving the conjugate in
saline (8 mg equiv. paclitaxel/ml). The injected volume at 60 mg/kg
was 0.975 ml per rat. .sup.bPaclitaxel Cremophor solution was
prepared by dissolving paclitaxel in a 1:1 mixture of ethyl alcohol
and Cremophor (30 mg/ml). This stock solution was further diluted
with saline (1:4) before injection. The final concentration of
paclitaxel in the solution was 6 mg/ml. The injected volume at 60
mg/kg was 1.3 ml per rat. .sup.cPG solution was prepared by
dissolving the polymer in saline (22 mg/ml). The injected dose was
0.3 g/kg (1.8 ml per rat), which was equivalent to paclitaxel dose
of 60 mg/kg. .sup.dCremophor vehicle was prepared by diluting a
mixture of ethyl alcohol and Cremophor (1:1) with saline (1:4).
TABLE-US-00003 TABLE 3 The Antitumor Effect of PG-TXL Against
Different Types of In vivo Murine Tumors Time to Grow.sup.bb Tumor
Drug.sup.a 500 2000 mm.sup.3 AGD.sup.c t-test.sup.d MCa-4 Saline
4.8 .+-. 0.8 (5) -- -- PG (0.6 g/kg) 9.3 .+-. 1.1 (4) 4.5 0.0114
Cremophor Vehicle 6.1 .+-. 0.7 (5) 1.3 0.265 PG-TXL (40 mg/kg) 8.6
.+-. 1.2 (4) 3.8 0.026 PG-TXL (60 mg/kg) 14.2 .+-. 1.1 (5) 9.4
0.0001 PG-TXL (120 mg/kg) 44.4 .+-. 2.9 (5) 39.6 <0.0001
Paclitaxel (40 mg/kg) 9.0 .+-. 0.6 (4) 4.2 0.0044 Paclitaxel (60
mg/kg) 9.3 .+-. 0.3 (5) 4.5 0.0006 Fsa-II Saline 1.9 .+-. 0.1 (5)
-- -- PG (0.8 g/kg) 2.8 .+-. 0.2 (6) 0.9 0.0043 Cremophor Vehicle
2.2 .+-. 0.2 (6) 0.3 0.122 PG-TXL (80 mg/kg) 3.8 .+-. 0.4 (6) 1.9
0.0016 PG-TXL (160 mg/kg) 5.1 .+-. 0.3 (13) 3.2 <0.0001
Paclitaxel (80 mg/kg) 4.2 .+-. 0.3 (6) 2.3 0.0002 PG + Paclitaxel
3.0 .+-. 0.2 (6) 1.1 0.0008 Hca-I Saline 7.3 .+-. 0.3 (5) -- -- PG
(0.8 g/kg) 7.7 .+-. 0.4 (4) 0.4 0.417 Cremophor Vehicle 6.8 .+-.
0.8 (5) -0.5 0.539 PG-TXL (40 mg/kg) 8.2 .+-. 0.7 (5) 0.9 0.218
PG-TXL (80 mg/kg) 8.6 .+-. 0.2 (5) 1.3 0.0053 PG-TXL (160 mg/kg)
11.0 .+-. 0.8 (4) 3.7 0.0023 Paclitaxel (80 mg/kg) 6.4 .+-. 0.5 (5)
-0.9 0.138 PG + Paclitaxel 6.7 .+-. 0.4 (5) -0.6 0.294 .sup.aMice
bearing 500 mm.sup.3 tumors in the right leg were treated with
various doses of PG-TXL (40 160 mg equiv. paclitaxel/kg) in saline
or paclitaxel in Cremophor vehicle i.v. in a single injection.
Control animals were treated with saline (0.6 ml), Cremophor
vehicle (0.5 ml), PG solution in saline, or PG g/kg) plus
paclitaxel (80 mg/kg). .sup.bTumor growth was determined by daily
measurement of three orthogonal diameters with calipers and the
volume was calculated as (A .times. B .times. C)/2. Shown in
brackets are the number of mice used in each group. The time in
days to grow from 6 = 500 mm.sup.3 to 2000 mm.sup.3 are presented
mean .+-. standard deviation. .sup.cAbsolute growth delay (AGD)
defined as the time in days for tumors treated with various drugs
to grow from 500 to 2000 mm.sup.3 minus the time in days for tumors
treated with saline control to grow from 500 to 2000 mm.sup.3.
.sup.dThe time in days to grow from 500 to 2000 mm.sup.3 were
compared for treatment groups and saline group using Student's
t-Test. P-values are two-sided and were taken to be significant
when less than to equal 0.05.
Two important findings emerged from these studies. First, like
paclitaxel, there is an intertumor variability of the antitumor
effect of water-soluble PG-TXL. PG-TXL is most effective against
MCa-4 and OCA-1 tumors. Second, PG-TXL is more effective than
paclitaxel on equivalent mg paclitaxel basis in the case of MCa-4,
HCa-I, and on OCA-1 tumors, and is remarkably potent at its maximum
tolerated dose (MTD).
In a parallel study, the antitumor activity of PG-TXL in Fischer
rats with the well established rat mammary adenocarcinoma 13762F
was examined. Femal Fischer 344 rats (125 150 g) were injected with
1.0.times.10.sup.5 viable 13762F tumor cells in 0.1 ml PBS. Once
tumors reached a mean volume of 2000 mm.sup.3 (mean diameter, 1.6
cm), animals were treated using a similar protocol as described
above. Tumor growth was determined daily by measuring three
orthogonal tumor diameters. Tumor volume was calculated according
to the formula (A.times.B.times.C)/2. A single dose of PG-TXL in
saline or paclitaxel in a Cremophor EL.RTM. vehicle was given in
doses varying from 20 to 60 mg equivalent paclitaxel/kg body
weight. In control studies, saline, the Cremophor EL.RTM. vehicle
[50/50 Cremophor/ethanol diluted with saline (1:4)], PG solution in
saline and paclitaxel plus PG were used. Again, complete tumor
eradication at the MTD of PG-TXL (60 mg equivalent paclitaxel/kg)
was observed. PG-TXL given at a lower dose of 40 mg equivalent
paclitaxel/kg also resulted in complete tumor regression (FIG. 7B).
In contrast, the MTD of paclitaxel in Cremophor EL.RTM. was less
than 20 mg/kg. Paclitaxel at this dose caused a tumor growth delay
(Tumor growth delay is defined as the time in days for tumors
treated with the test drugs to grow from 2,000 mm.sup.3 to 10,000
mm.sup.3 minus the time in days for tumors treated with saline
control to grow from 2,000 mm.sup.3 to 10,000 mm.sup.3) of only 5
days, whereas the same equivalent paclitaxel dose of PG-TXL
resulted in a tumor growth delay of 23 days (FIG. 7B).
Studies of Nude Mice Injected with Human Breast Cancer and Treated
with PG-TXL
Nude mice were injected with 2.times.10.sup.6 MDA-435-Lung2 cells
(a variant of the MDA-MB-435 human breast cancer cell line) into
the mammary fatpad. When the tumors reached 5 mm mean diameter, (27
days after tumor injection), mice were treated with an i.v.
injection of PG-TXL or the various controls (see Table 4). Tumor
measurements were taken weekly. Tumors that reached 1.5 cm were
removed surgically. All mice were killed at 120 days, and remaining
tumors removed and weighed. Mice were examined for metastases, and
Lungs processed for histology, with single sections of the organs
scored for the presence of micrometastases.
TABLE-US-00004 TABLE 4 Mean tumor No. tumors Lung Treatment Tumor
take.sup.a wt(g).sup.b regressed.sup.c metastases.sup.d PBS 5/6 1.3
.+-. 0.24 -- 4/5 (80%) Cremophor 9/9 1.26 .+-. 0.67 -- 4/8 (50%)
PGA 10/10 1.13 .+-. 0.7 -- 4/7 (57%) Taxol .TM./ 10/10 1.31 .+-.
0.69 -- 3/7 (42%) Cremophor 60 mg/kg PG-TXL 60 10/10 1.23 .+-. 0.38
2/10 5/8 mg/kg (62.5%) PG-TXL 120 9/10 0.925 .+-. 0.12 4/8 1/4
(25%) mg/kg .sup.aNumber of mice with 5 mm tumors at time of
therapy/number of mice injected .sup.bMean weight of tumors removed
at time of autopsy .sup.cNumber of tumors that had regressed at
time of autopsy .sup.dNumber of mice with lung metastases (either
macroscopic or found in histology preparations)/number of mice with
tumors. Some discrepancies between tumor take and number mice with
tumors in this column due to sacrifice or deaths of animals for
non-related reasons, e.g., developing Staphylococcus abscesses. One
mouse in PG-TXL 120 mg group was killed due to extreme weight loss
after treatment; otherwise there were no obvious therapy related
deaths. Nude mice couldn't tolerate 160 mg/kg equivalent of
PG-TXL.
From the results of the study in which a single bolus of
PG-conjugated paclitaxel (PG-TXL) was given, at a drug equivalent
of 120 mg/kg paclitaxel, it is apparent that the MDA-435 cancer
cell line responds to the drug and that this formulation of the
drug is much better tolerated than when Cremophor is the
vehicle.
In the breast cancer study using MDA-MB-435, only the higher dose
of PG-TXL inhibited the growth rate of the mammary fatpad tumors.
From the growth curve it was apparent that tumor growth resumed
approximately 30 days after the single dose of conjugate. However,
the growth curve does not reveal that in the PG-TXL 120 mg/kg group
there were a number of tumor regressions. As shown in Table 3, the
incidence of lung metastasis in the mice with residual tumors was
also reduced. While the numbers of mice in the study are small,
they do suggest that the therapy was effective in reducing both
local tumor growth and incidence of metastasis.
In this study design it is not possible to distinguish whether a
lower incidence of metastasis is due to a reduction of tumor mass
of the primary site, or due to a direct effect on any
micrometastases that may have already been established at the time
of therapy.
In vivo Therapy of Human Breast Cancer Using Multiple Injections of
PG-TXL
To test the effect of multiple injections of PG-TXL, nude mice were
injected with 2.times.10.sup.6; MDA-435-Lung 2 cells (a variant of
the MDA-MB-435 human breast cancer cell line) into the mammary
fatpad. When the tumors reached 5 mm mean diameter, the treatments
were started, and repeated at 14 day intervals (day 24, 38, 52) for
a total of three injections. Tumor measurements were taken weekly.
The mice were killed on day 105 after tumor cell injection, and the
tumor weights and incidence of metastasis recorded. The lungs were
processed for histology, and single sections scored for the
presence of micrometastases. The results are shown in Table 5.
TABLE-US-00005 TABLE 5 Tumor Tumors Treatment take.sup.a Mean
weight(g).sup.b regressed.sup.c Metastasis.sup.d 4/4 (100%) None
4/5 1.83 .+-. 0.15 -- 5/6 (83%) PG-control 6/10 1.7 .+-. 0.11 --
6/7 (86%) PG-TXL/60 7/10 1.36 .+-. 0.28 -- mg PG-TXL/120 8/10 0.97
.+-. 0.22 p = 0.011e -- 2/6 (33%) mg Legend: .sup.aNumber of mice
with 5 mm tumors at the time of therapy/number of mice injected
.sup.bMean weight of tumors (.+-.SEM) .sup.cNumber of tumors that
had regressed at the time of autopsy .sup.dNumber of mice with lung
metastases, either macroscopic or microscopic/number of mice with
tumors .sup.ep value from unpaired t test comparing tumor weight of
treated mice with the control PG group.
In vivo Therapy of Human Ovarian Cancer Using PG-TXL Conjugate
Nude mice were injected i.p. with the human ovarian cancer cell
line, SKOV3ipl. Five days after tumor injection, the mice were
injected i.v. with the PG-paclitaxel (PGTXL), at concentrations
equivalent to 120 mg/kg or 160 mg/kg of paclitaxel. Initially the
plan was to repeat these injections at 7-day intervals, but a
single injection of the 160 mg/kg dose killed 5 of the 10 mice.
Only the 120 mg/kg group received three injections. The study was
terminated on day 98, and any surviving mice killed. The results
are shown in FIG. 14, and in Table 6.
The median survival values for the groups at present are:
untreated=47 days, PC-control=43 days, PG-TXL (120 mg/kg)=83 days,
PG-TXL (160 mg/kg)=83 days [note that this does not include the
mice that died from the initial toxicity of the drug].
TABLE-US-00006 TABLE 6 Median survival Mean vol Treatment Tumor
take.sup.a (range).sup.b Ascites.sup.c (ml).sup.d None 10/10 56 (38
98) 8/10 2.2 .+-. 1.6 PG-control 8/9 45 (39 98) 8/8 2.2 .+-. 1.6
PG-120 7/8 82 (59 98) 3/7 2.7 .+-. 1.4 PG-160 3/5.sup.e 84
(34.sup.f 98) 0/3 Legends: .sup.aIncidence of tumor/number of mice
injected .sup.bmedian survival time in days .sup.cincidence of
ascites/number of mice with tumor .sup.dmean volume (and s.d.) of
ascites .sup.ethese mice only received a single dose of
PG-paclitaxel, 160 mg/kg, and does not include the mice that dies
within 5 days of the treatment .sup.fthe mouse that was killed on
day 34 had minimal tumor burden, but was paraplegic (possible
toxicity?).
The PG-TXL 120 mg/kg significantly extended the survival of the
mice with intraperitoneal SKOV3ipl, (a human ovarian cancer cell
line which overexpresses HER2/neu), compared with mice injected
with PG alone. Multiple doses and/or increasing the dose of
conjugate may significantly reduce the tumor incidence in addition
to extending survival.
In the nude mice studies above, the growth curves show that
although breast cancer growth is checked by paclitaxel, especially
with the higher dose conjugated with PG, tumor size continues to
increase about a month after the therapy. A second (or third) round
of therapy may have caused the tumor growth to plateau, or give
more tumor regressions. The growth curves do not include the tumors
that regressed--as shown in Table 4, the tumors shrank/disappeared
in 50% of the mice treated with the highest dose of PG-TXL and of
the 4 animals with progressively growing tumors at the end of the
study, only one had micrometastases in the lungs. So the treatment
that reduced growth of the primary tumors also reduced the
incidence of metastasis. The incidence of metastasis in all other
therapy groups, including the control groups of Cremophor and PG
were lower than the PBS control, therefore it is probably not valid
to state that the reduction in incidence of metastasis in the
Taxol.TM./Cremophor group is a significant finding.
EXAMPLE 2
DTPA-Paclitaxel
Synthesis of DTPA-Paclitaxel:
To a solution of paclitaxel (100 mg, 0.117 mmol) in dry DMF (2.2
ml) was added diethylenetriaminepentaacetic acid anhydride (DTPA A)
(210 mg, 0.585 mmol) at 0.degree. C. The reaction mixture was
stirred at 4.degree. C. overnight. The suspension was filtered (0.2
.mu.m Millipore filter) to remove unreacted DTPA anhydride. The
filtrate was poured into distilled water, stirred at 4.degree. C.
for 20 min, and the precipitate collected. The crude product was
purified by preparative TLC over C.sub.18 silica gel plates and
developed in acetonitrile/water (1:1). Paclitaxel had an Rf value
of 0.34. The band above the paclitaxel with an R.sub.f value of
0.65 to 0.75 was removed by scraping and eluted with an
acetonitrile/water (1:1) mixture, and the solvent was removed to
give 15 mg of DTPA-paclitaxel as product (yield 10.4%): mp:
>226.degree. C. dec. The UV spectrum (sodium salt in water)
showed maximal absorption at 228 nm which is also characteristic
for paclitaxel. Mass spectrum: (FAB) m/e 1229 (M+H).sup.+,
.sup.1251(M+Na), 1267 (M+K). In the .sup.1H NMR spectrum
(DMSO-d.sub.6) the resonance of NCH2CH2N and CH2COOH of DTPA
appeared as a complex series of signals at .delta. 2.71 2.96 ppm,
and as a multiplet at .delta. 3.42 ppm, respectively. The resonance
of C7-H at 4.10 ppm in paclitaxel shifted to 5.51 ppm, suggesting
esterification at the 7-position. The rest of the spectrum was
consistent with the structure of paclitaxel.
The sodium salt of DTPA-paclitaxel was also obtained by adding a
solution of DTPA-paclitaxel in ethanol into an equivalent amount of
0.05 M NaHCO3, followed by lyophilizing to yield a water-soluble
solid powder (solubility>20 mg equivalent paclitaxel/ml).
Hydrolytic Stability of DTPA-Paclitaxel:
The hydrolytic stability of DTPA-paclitaxel was studied under
accelerated conditions. Briefly, 1 mg of DTPA-paclitaxel was
dissolved in 1 ml 0.5 M NaHCO3 aqueous solution (pH 9.3) and
analyzed by HPLC. The HPLC system consisted of a Waters
150.times.3.9 (i.d.) mm Nova-Pak column filled with C18 4 .mu.m
silica gel, a Perkin-Elmer isocratic LC pump, a PE Nelson 900
series interface, a Spectra-Physics UVN is detector and a data
station. The eluant (acetonitrile/methanol/0.02M ammonium
acetate=4:1:5) was run at 1.0 ml/min with UV detection at 228 nm.
The retention times of DTPA-paclitaxel and paclitaxel were 1.38 and
8.83 min, respectively. Peak areas were quantitated and compared
with standard curves to determine the DTPA-paclitaxel and
paclitaxel concentrations. The estimated half-life of
DTPA-paclitaxel in 0.5 M NaHCO3 solution is about 16 days at room
temperature.
Effects of DTPA-Paclitaxel on the Growth of B16 Mouse Melanoma
Cells In vitro
Cells were seeded in 24-well plates at a concentration of
2.5.times.10.sup.4 cells/ml and grown in a 50:50 Dulbecco's
modified minimal essential medium (OEM) and F12 medium containing
10% bovine calf serum at 37.degree. C. for 24 h in a 97% humidified
atmosphere of 5.5% CO.sub.2. The medium was then replaced with
fresh medium containing paclitaxel or DTPA-paclitaxel in
concentration ranging from 5.times.10.sup.-9 M to
75.times.10.sup.-9 M. After 40 h, the cells were released by
trypsinization and counted in a Coulter counter. The final
concentrations of DMSO (used to dissolve paclitaxel) and 0.05 M
sodium bicarbonate solution (used to dissolve DTPA-paclitaxel) in
the cell medium were less than 0.01%. This amount of solvent did
not have any effect on cell growth as determined by control
studies.
The effects of DTPA-paclitaxel on the growth of B16 melanoma cells
are presented in FIG. 2. After a 40-h incubation with various
concentrations, DTPA-paclitaxel and paclitaxel were compared as to
cytotoxicity. The IC.sub.50 for paclitaxel and DTPA-paclitaxel are
15 nM and 7.5 nM, respectively.
Antitumor Effect on Mammary Carcinoma (MCa-4) Tumor Model:
Female C3Hf/Kam mice were inoculated with mammary carcinoma (MCa-4)
in the muscles of the right thigh (5.times.10.sup.5 cells/mouse).
When the tumors had grown to 8 mm (approx. 2 wks), a single dose of
paclitaxel or DTPA-paclitaxel was given at 10, 20 and 40 mg
equivalent paclitaxel/kg body weight. In control studies, saline
and absolute alcohol/Cremophor 50/50 diluted with saline (1:4) were
used. Tumor growth was determined daily, by measuring three
orthogonal tumor diameters. When the tumor size reached 12 mm in
diameter, the tumor growth delay was calculated. The mice were
sacrificed when tumors were approximately 15 mm.
The tumor growth curve is shown in FIG. 3. Compared to controls,
both paclitaxel and DTPA-paclitaxel showed antitumor effect at a
dose of 40 mg/kg. The data were also analyzed to determine the mean
number of days for the tumor to reach 12 mm in diameter.
Statistical analysis showed that DTPA-paclitaxel delayed tumor
growth significantly compared to the saline treated control at a
dose of 40 mg/kg (p<0.01). The mean time for the tumor to reach
12 mm in diameter was 12.1 days for DTPA-paclitaxel compared to 9.4
days for paclitaxel (FIG. 4).
Radiolabeling of DTPA-Paclitaxel with .sup.111In
Into a 2-mi V-vial were added successively 40 .mu.l 0.6 M sodium
acetate (pH 5.3) buffer, 40 .mu.1 0.06 M sodium citrate buffer (pH
5.5), 20 .mu.l DTPA-paclitaxel solution in ethanol (2% w/v) and 20
.mu.1 .sup.111InCl.sub.3 solution (1.0 mCi) in sodium acetate
buffer (pH 5.5). After an incubation period of 30 min at room
temperature, the labeled .sup.111In-DTPA-paclitaxel was purified by
passing the mixture through a C18 Sep-Pac cartridge using saline
and subsequently ethanol as the mobile phase. Free .sup.111In-DTPA
(<3%) was removed by saline, while .sup.111In-DTPA-paclitaxel
was collected in the ethanol wash. The ethanol was evaporated under
nitrogen gas and the labeled product was reconstituted in saline.
Radiochemical yield: 84%.
Analysis of .sup.111In-DTPA-Paclitaxel:
HPLC was used to analyze the reaction mixture and purity of
.sup.111In-DTPA-paclitaxel. The system consisted of a LDC binary
pump, a 100.times.8.0 mm (i.d.) Waters column filled with ODS 5
.mu.m silica gel. The column was eluted at a flow rate of 1 ml/min
with a gradient mixture of water and methanol (gradient from 0% to
85% methanol over 15 min). The gradient system was monitored with a
NaI crystal detector and a Spectra-Physics UVIVis detector. As
evidenced by HPLC analysis, purification by Sep-Pak cartridge
removed most of the .sup.111In-DTPA, which had a retention time of
2.7 min. The .sup.111In-DTPA was probably derived from traces of
DTPA contaminant in the DTPA-paclitaxel. A radio-chromatogram of
.sup.111In-DTPA-paclitaxel correlated with its UV chromatogram,
indicating that the peak at 12.3 min was indeed the target
compound. Under the same chromatographic conditions, paclitaxel had
a retention time of 17.1 min. The radiochemical purity of the final
preparation was 90% as determined by HPLC analysis.
Whole-Body Scintigraphy:
Female C3Hf/Kam mice were inoculated with mammary carcinoma (MCa-4)
in the muscles of the right thigh (5.times.10.sup.5 cells). When
the tumors had grown to 12 mm in diameter, the mice were divided
into two groups. In group I, the mice were anesthetized by
intraperitoneal injection of sodium pentobarbital, followed by
.sup.111In-DTPA-paclitaxel (100 200 mCi) via tail vein. A
.gamma.-camera equipped with a medium energy collimator was
positioned over the mice (3 per group). A series of 5 min
acquisitions were collected at 5, 30, 60, 120, 240 min and 24 h
after injection. In group II, the same procedures were followed
except that the mice were injected with .sup.111In-DTPA as a
control. FIG. 5 shows gamma-scintigraphs of animals injected with
.sup.111In-DTPA and .sup.111In-DTPA-paclitaxel. .sup.111In-DTPA was
characterized by rapid clearance from the plasma, rapid and high
excretion in the urine with minimal retention in the kidney and
negligible retention in the tumor, the liver, the intestine and
other organs or body parts. In contrast, .sup.111In-DTPA-paclitaxel
exhibited a pharmacological profile resembling that of paclitaxel
(Eiseman et al., 1994). Radioactivity in the brain was negligible.
Liver and kidney had the greatest tissue:plasma ratios.
Hepatobiliary excretion of radiolabeled DTPA-paclitaxel or its
metabolites was one of the major routes for the clearance of the
drug from the blood. Unlike paclitaxel, a significant amount of
"In-DTPA-paclitaxel was also excreted through kidney, which only
played aminor role in the clearance of paclitaxel. The tumor had
significant uptake of .sup.111In-DTPA-paclitaxel. These results
demonstrate that .sup.111In-DTPA-paclitaxel is able to detect
certain tumors and to quantify the uptake of
.sup.111In-DTPA-paclitaxel in the tumors, which in turn, may assist
in the selection of patients for the paciitaxel treatment. In
contrast, the smaller PG-TXL conjugate has a different distribution
than DTPA-paclitaxel, and partly localizes in the liver and tumors
of test animals.
EXAMPLE 3
Polyethylene glycol-Paclitaxel
Synthesis of Polyethylene Glycol-Paclitaxel (PEG-Paclitaxel)
The synthesis was accomplished in two steps. First
2'-succinyl-paclitaxel was prepared according to a reported
procedure (Deutsch et al., 1989). Paclitaxel (200 mg, 0.23 mmol)
and succinic anhydride (288 mg, 2.22 mmol) were allowed to react in
anhydrous pyridine (6 ml) at room temperature for 3 h. The pyridine
was then evaporated, and the residue was treated with water,
stirred for 20 min, and filtered. The precipitate was dissolved in
acetone, water was slowly added, and the fine crystals were
collected to yield 180 mg 2'-succinyl-paclitaxel. PEG-paciitaxel
was synthesized by an
N-ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline (EEDQ) mediated
coupling reaction. To a solution of 2'-succinyl-paclitaxel (160 mg,
0.18 mmol) and methoxypolyoxyethylene amine (PEG-NH.sub.2, MW 5000,
900 mg, 0.18 mmol) in methylene chloride was added EEDQ (180 mg,
0.72 mmol). The reaction mixture was stirred at room temperature
for 4 h. The crude product was chromatographed on silica gel with
ethyl acetate followed by chloroform-methanol (10:1). This gave 350
mg of product. .sup.1H NMR (CDCl.sub.3) .delta. 2.76 (m, succinic
acid, COCH.sub.2CH.sub.2CO.sub.2), .delta. 3.63 (PEG,
OCH.sub.2CH.sub.2O), .delta. 4.42 (C7-H) and .delta. 5.51 (C2'-H).
Maximal UV absorption was at 288 nm which is also characteristic
for paclitaxel. Attachment to PEG greatly improved the aqueous
solubility of paclitaxel (>20 mg equivalent paclitaxel/ml
water).
Hydrolytic Stability of PEG-Paclitaxel
PEG-Paclitaxel was dissolved in phosphate buffer (0.01 M) at
various pHs at a concentration of 0.4 mM and the solutions were
allowed to incubate at 37.degree. C. with gentle shaking. At
selected time intervals, aliquots (200 .mu.l) were removed and
lyophilized. The resulting dry powders were redissolved in
methylene chloride for gel permeation chromatography (GPC
analysis). The GPC system consisted of a Perkin-Elmer PL gel mixed
bed column, a Perkin-Elmer isocratic LC pump, a PE Nelson 900
series interface, a Spectra-Physics UVN is detector and a data
station. The elutant (methylene chloride) was run at 1.0 ml/min
with the UV detector set at 228 nm. The retention times of
PEG-paclitaxel and paclitaxel were 6.1 and 8.2 min, respectively.
Peak areas were quantified and the percentage of PEG-paclitaxel
remaining and the percentage of paclitaxel released were
calculated. The half life of PEG-paclitaxel determined by linear
least-squares at pH 7.4 was 54 min. The half-life at pH 9.0 was 7.6
min. Release profiles of paclitaxel from PEG-paclitaxel at pH 7.4
is shown in FIG. 8.
Cytotoxicity Studies of PEG-Paclitaxel Using B16 Mouse Melanoma
Cells In Vitro
Following the procedure described in the cytotoxicity studies with
DTPA-paclitaxel melanoma cells were seeded in 24-well plates at a
concentration of 2.5.times.10.sup.4 cells/ml and grown in a 50:50
Dulbecco's modified minimal essential medium (DME) and F12 medium
containing 10% bovine calf serum at 37.degree. C. for 24 h in a 97%
humidified atmosphere of 5.5% CO.sub.2. The medium was then
replaced with fresh medium containing paclitaxel or its derivatives
in concentrations ranging from 5.times.10.sup.-9 M to
75.times.10.sup.-9 M. After 40 h, the cells were released by
trypsinization and counted in a Coulter counter. The final
concentrations of DMSO (used to dissolve paclitaxel) and 0.05 M
sodium bicarbonate solution (used to dissolve PEG-paclitaxel) in
the cell medium were less than 0.01%. This amount of solvent did
not have any effect on cell growth as determined by control
studies. Furthermore, PEG in the concentration range used to
generate an equivalent paclitaxel concentration from
5.times.10.sup.-9 M to 75.times.10.sup.-9 M also did not effect
cell proliferation.
Antitumor Effect of PEG-Paclitaxel Against MCa-4 Tumor in Mice
To evaluate the antitumor efficacy of PEG-paclitaxel against solid
breast tumors, MCa-4 cells (5.times.10.sup.5 cells) were injected
into the right thigh muscle of female C3Hf/Kam mice. As described
in Example 1 with the DTPA-paclitaxel, when the tumors were grown
to 8 mm (Approx. 2 wks), a single dose of paclitaxel or
PEG-paclitaxel was given at 10, 20 and at 40 mg equivalent
paclitaxel/kg body weight. Paclitaxel was initially dissolved in
absolute ethanol with an equal volume of Cremophor. This stock
solution was further diluted (1:4 by volume) with a sterile
physiological solution within 15 min of injection. PEG-paclitaxel
was dissolved in saline (6 mg equiv. paclitaxel/ml) and filtered
through a sterile filter (Millipore, 4.5 .mu.m). Saline, paclitaxel
vehicle, absolute alcohol:Cremophor (1:1) diluted with saline (1:4)
and PEG solution in saline (600 mg/kg body weight) were used in
control studies. Tumor growth was determined daily, by measuring
three orthogonal tumor diameters. When the tumor size reached 12 mm
in diameter, the tumor growth delay was calculated.
The tumor growth curve is shown in FIG. 9. At a dose of 40 mg/kg,
both PEG-paclitaxel and paclitaxel effectively delayed tumor
growth. Paclitaxel was more effective than PEG-paclitaxel, although
the difference was not statistically significant. Paclitaxel
treated tumors required 9.4 days to reach 12 mm in diameter whereas
PEG-paclitaxel-treated tumors required 8.5 days. Statistically,
these values were significant (p>0.05) as compared to their
corresponding controls, which were 6.7 days for the paclitaxel
vehicle and 6.5 days for the saline solution of PEG (FIG. 4).
EXAMPLE 5
Poly(L-glutamic Acid)-Paclitaxel (PG-TXL) and Paclitaxel
Pharmacological Properties
The objective of this study was to compare PG-TXL and paclitaxel
pharmacological properties in their ability to promote in vitro
assembly of tubulin, to inhibit cell growth against rat mammary
tumor cell line 13762F and human breast tumor cell lines, to induce
p53 protein, and to rescue a paclitaxel-dependent mutant cell line.
Paclitaxel's release from PG-TXL in vivo was measured to determine
if PG-TXL's mechanism of action can be attributed to free
pacitaxel.
Microtubule Polymerization Using Poly-Glutamic Acid-Paclitaxel
(PG-TXL) and Paclitaxel
To test whether intact PG-TXL has any intrinsic biological activity
in promoting tubulin polymerization, paclitaxel, PG-TXL, and "aged"
PG-TXL were compared for their relative ability to promote in vitro
assembly of purified bovine brain tubulin. The tubulin assembly
reaction was performed at 32.degree. C. in PEM buffer (80 mM PIPES
buffer, 1 mM EGTA, 1 mM MgCl.sub.2, pH 6.9) at a tubulin (bovine
brain, Cytoskeleton Inc., Boulder, Colo.) concentration of 1 mg/ml
(10 .mu.M) in the presence or absence of drugs (1.0 .mu.M
equivalent paclitaxel) and 1.0 mM guanosine 5'-triphosphate (GTP).
"Aged" PG-TXL was obtained by placing PG-TXL in PBS (pH 7.4) at
37.degree. C. for 3 days. Tubulin polymerization was followed by
measuring the absorbance of the solution at 340 nm over time.
Addition of 1 .mu.M paclitaxel to a solution of tubulin in assembly
buffer caused a clear increase in absorbance due to the increase in
light scattering resulting from the polymerization of tubulin into
microtubules. In contrast, a 10 .mu.M paclitaxel equivalent of
PG-TXL had no effect on polymerization. A solution of the conjugate
that was "aged" for 3 days in PBS (pH 7.4) at 37.degree. C.
exhibited enhanced activity although its ability to promote tubulin
polymerization was still markedly less than paclitaxel (FIG.
10).
Effects of Poly-Glutamic Acid-Paclitaxel (PG-TXL) on the Growth of
Rat and Human Tumor Cell Lines in vitro
To evaluate whether the superior antitumor activity of PG-TXL
observed in animals is due to increased cytotoxicity, PG-TXL and
paclitaxel were compared for their ability to inhibit cell growth
against the established rat mammary tumor cell line 13762F. The
effect of PG-TXL on cell growth was examined by a plating
efficiency assay. Rat 13762F cells were seeded (200 cells) into 60
mm dishes containing drug concentrations varying from 0 to 200 nM
in growth medium (.alpha. modified minimum essential medium
[.alpha.-MEM] containing 5% fetal bovine serum, 50 U/ml of
penicillin, and 50 .mu.g/ml of streptomycin). After 6 days of
growth, the cells were stained with a 0.1% methylene blue solution
and colonies were counted. The drug concentration producing 50%
inhibition of colony formation (IC.sub.50) was then calculated. The
approximate IC.sub.50 values after 6 days of continuous exposure
were: paclitaxel (2 nM), PG-TXL (100 nM), "aged" (see below) PG-TXL
(50 nM). It is clear that PG-TXL is approximately 30 50 fold less
potent than paclitaxel itself. When PG-TXL was incubated in
phosphate buffered saline solution (PBS, pH 74) at 37.degree. C.
for 3 days to obtain an "aged" solution, only about 10% of
paclitaxel was released. Since the "aged" solution is more potent
than freshly dissolved PG-TXL, the in vitro degradation of PG-TXL
or release of active drug appears to be important for PG-TXL to
exert this biological activity. However, even after "aging," PG-TXL
is still 25 times less potent than paclitaxel.
In a similar study, the effect of PG-TXL on cell growth of human
breast cancer cell lines was examined by MTT assay after 3 days of
continuous exposure. While PG-TXL was 8-and 30-fold more potent
than paclitaxel against MDA330 and MDA-MB453 cell lines, PG-TXL was
2- and 3-fold less potent than paclitaxel against MCF7/her-2 and
MCF7 cell lines. These results suggest that PG-TXL and paclitaxel
have different activity against different cell lines. PG-TXL may be
a product with distinct pharmacological properties different from
that of paclitaxel.
The Ability of Poly-Glutamic Acid-Paclitaxel (PG-TXL) to Support a
Paclitaxel-Dependent Cell Line in vitro
The inventors investigated the ability of PG-TXL to rescue a
paclitaxel-dependent mutant cell line. Tax 18, a CHO cell line
selected for resistance to paclitaxel, is a well characterized
mutant that has been found to require the continuous presence of
paclitaxel for cell division. In the absence of drug, a functional
mitotic spindle apparatus is unable to form (Cabral et al. 1983).
The mitosis phase of the cell cycle is prolonged with subsequent
failure to segregate chromosomes and to divide into daughter cells.
Nonetheless, the cells continue to progress through the cell cycle
and replicate their DNA resulting in the formation of large
polyploid cells that eventually die due to genomic instability
(Cabras and Barlow, 1991). Low concentrations of paclitaxel are
able to rescue the mutant phenotype by permitting microtubule
assembly and the formation of sufficient mitotic spindle fibers.
Thus, these cells provide a convenient bioassay-for agents that
promote microtubule assembly. Growth of paclitaxel-dependent CHO
mutant Tax-18 cells was carried out on 24-well tissue culture
dishes. Approximately 100 cells were added to wells containing
growth medium and equivalent concentrations of paclitaxel varying
from 0 to 1.0 .mu.M. After 6 days of incubation at 37.degree. C.,
the medium was removed and the cells were stained with methylene
blue.
Little or no increase in cell number is seen in the absence of
drug, but concentrations of paclitaxel between 0.05 0.2 .mu.M
clearly support the growth of this cell line. Higher concentrations
of paclitaxel are presumably toxic to the cells because of
overstabilization of the microtubules as is observed for normal
cells. On the other hand, freshly prepared PG-TXL shows little
ability to rescue Tax-18 cell growth even at the highest
paclitaxel-equivalent concentration tested (1 .mu.M). When PG-TXL
was "aged" by incubating in PBS for 6 days at 37.degree. C., its
ability to support Tax-18 cell growth was partially restored. These
data indicate that PG-TXL does not promote microtubule assembly,
and that the in vitro biological activity of "aged" PG-TXL is a
contribution of paclitaxel released from poly-glutamic
acid-paclitaxel (PG-TXL).
The Release of [.sup.3H]paclitaxel from PG-[.sup.3H]TXL in vivo
To assess the pharmacokinetic and release characteristics of
paclitaxel in vivo, normal female C3Hf/Kam mice (25 30 g) were
injected with a dose of 20 mg equivalent [.sup.3H]paclitaxel or
PG-[.sup.3H]paclitaxel intravenously into the tail vein. Each mouse
received 6 .mu.Ci of radiolabeled drug. [.sup.3H]paclitaxel was
dissolved in Cremophor EL.RTM. vehicle whereas
PG-[.sup.3H]paclitaxel was dissolved in saline. Volume injected
into each mice was between 0.2 to 0.3 ml. At 0, 5, 15, 30 min, and
1, 2, 4, 8,16, 24, 48 h postinjection, animals were sacrificed and
blood samples were collected (4 5 mice per time point). Total
radioactivity in plasma was measured by liquid scintillation
counting (Beckman Model LS 6500, Fullerton, Calif.) using 10 .mu.l
aliquots of plasma. Up to 200 .mu.l plasma was extracted with 3
volume of ethyl acetate according to Longnecker et al (1987). The
extraction efficiency for paclitaxel was 80%. The samples were
centrifuged for 5 min at 2500 rpm, and the supernatant was
separated and brought to dryness. The dried extract was
reconstituted with 195 .mu.l of HPLC mobile phase, mixed with 5
.mu.l of cold paclitaxel (0.2 mg/ml), and 100 .mu.l was injected
onto the HPLC for determination of free paclitaxel radioactivity.
Pharmacokinetic parameters were analyzed by a noncompartmental
model using the WinNonlin software package. Each data point
generated was the mean value of 4-5 mice.
The clearance of both drugs from plasma is shown in FIG. 11. While
paclitaxel has an extremely short half life in plasma of mice
(t.sub.1/2, 29 min), the apparent half life of PG-TXL is prolonged
(t.sub.1/2, 317 min). Slower clearance of PG-TXL from the blood was
a design feature of the polymer-drug conjugate with the goal of
improving tumor uptake. Surprisingly, the rate of conversion of
PG-TXL to paclitaxel in plasma is slow with less than 0.1% of the
radioactivity from PG-[.sup.3H]TXL being recovered as
[.sup.3H]paclitaxel within 144 h after drug injection (FIG.
11).
In a separate study, mice bearing OCA-1 tumors were prepared as
described previously. When the tumor reached 500 mm.sup.3, animals
were injected with a dose of 20 mg equivalent paclitaxel/kg of
[.sup.3H]paclitaxel or PG-[.sup.3H]TXL into the tail vein. Animals
were killed at 2, 5, 9, 24, 48, and 144 h postinjection. Tumors
were removed, weighed, and homogenized with 3 volume of PBS (w/v).
Percent of injected dose per gram tissue is calculated based on
total radioactivity associated with the tumor, which was determined
by counting prepared tissue homogenate aliquots. An aliquot of
tissue homogenate was mixed with tissue solubilizer, followed by
addition of scintillation solvent, and counted for total
radioactivity. The counting efficiency was verified by the method
of standard addition. Alternatively, aliquots of tissue homogenates
were extracted with ethyl acetate and analyzed for free paclitaxel
by HPLC. The HPLC system consisted of a 150.times.3.9 mm Nova-Pak
column (Waters, Milford, Mass.), a liquid chromatography pump
(Waters model 510), a UVN is detector set at 228 nm (Waters model
486), a flow scintillation analyzer (Packard model 500TR, Downers
Grove, Ill.), and a Packard radiomatic software for data analysis.
The eluting solvent (methanol:watter=2:1) was run at 1.0 ml/min.
The uptake of total drugs in OCA-1 tumor was expressed as a
percentage of the administered dose per gram of tissue and the
association of radioactivity within OCA-1 tumor as free paclitaxel
was expressed as dpm per gram tissue.
Quantitative assessment of tumor uptake in C3Hf/Kam mice showed
that relatively high levels of radioactivity from radiolabeled
PG-TXL appear in tumor tissue shortly after injection (FIG. 12A) as
compared to radiolabeled paclitaxel. However, only small amounts of
radioactivity within tumor tissue are due to the release of free
paclitaxel (FIG. 12B). Data are presented in FIG. 12A and FIG. 12B
as mean.+-.SD from 3 mice per time point. The percent of
radioactivity within tumor tissue due to paclitaxel does not
appreciably increase with time suggesting that PG-TXL is not simply
a prodrug for the gradual release of paclitaxel.
In contrast to paclitaxel, in vitro studies with PG-TXL whether
prepared as a fresh solution or even after "aging" in buffer have
clearly shown that the complex is not a potent cytotoxic species.
It neither strongly supports tubulin polymerization nor the growth
and survival of a paclitaxel-dependent CHO cell line. Furthermore,
data obtained from pharmacokinetic studies indicate that both the
extent and rate of release of paclitaxel in plasma is very low
(less than 0.1% in 144 h). While the uptake of PG-TXL material was
some 5-fold greater than that achieved by paclitaxel when using
equivalent antitumor doses, that material which gains entry into
tissues exists in the tissue mainly in form(s) which have been
shown not to be free paclitaxel.
EXAMPLE 6
Effect of Polymer Structure on Activity of Water soluble polyamino
Acid-Paclitaxel Conjugates
The present study evaluated whether antitumor activities of
polymer-paclitaxel conjugates were affected by the structure of
polyamino acids used for drug conjugation. Paclitaxel was coupled
to poly(l-glutamic acid), poly(d-glutamic acid), and
poly(l-aspartic acid) according to previously described procedures.
These polyamino acidpaclitaxel conjugates had similar paclitaxel
content, aqueous solubility, and molecular weight (30 40K). In
C3Hf/Kam mice bearing murine OCA-1 ovarian cancer (500 mm.sup.3 at
time of treatment), a single i.v. injection of poly(l-glutamic
acid)-paclitaxel at 80 mg equiv. paclitaxel/kg body weight produced
a tumor growth delay of 21 days vs. saline treated controls.
Poly(d-glutamic acid)-paclitaxel was as effective as
poly(l-glutamic acid)-paclitaxel. However, paclitaxel conjugated
with poly(l-aspartic acid) was completely inactive against OCA-1
tumor. In a separate study, the antitumor activity of
polymer-paclitaxel conjugates of different molecular weight (1 K,
13K, and 36K) was compared. Conjugates of lower molecular weight
were significantly less effective than conjugate of higher
molecular weight. The higher molecular weights above 50,000 was too
viscous.
EXAMPLE 7
Poly-glutamic Acid-Paclitaxel (PG-TXL) Induces less Apoptosis
Compared to Paclitaxel
To assess the mechanism of PG-TXL associated antitumor activity,
histological sections of OCA-1 tumors excised from paclitaxel and
PG-TXL treated mice were examined. OCA-1 tumor bearing mice were
prepared as previously described. When tumor volume reached 500
mm.sup.3, animals were injected with either paclitaxel (80 mg/kg)
or PG-TXL (160 mg equivalent paclitaxel/kg). At different times
ranging from 0 to 144 h after treatment, tumors were histologically
analyzed to quantify mitotic and apoptotic activity according to
Milas et al. (1995). The mice were killed by cervical dislocation
and the tumors were immediately excised and placed in
neutral-buffered formalin. The tissues were then processed and
stained with hematoxylin and eosin. Both mitosis and apoptosis were
scored in coded slides by microscopic examination at 400.times.
magnification. Five fields of normecrotic areas were randomly
selected in each histological specimen, and in each field the
number of apoptotic nuclei and cells in mitosis were recorded as
numbers per 100 nuclei and were expressed as a percentage. The
values were based on scoring 1500 nuclei obtained from 3 mice per
time point.
The changes observed in the paclitaxel-treated mice were
qualitatively similar to those previously described (Milas et al.,
1995). The tumor cells showed marked nuclear fragmentation with
formation of apoptotic bodies, which was especially marked on day 1
(FIG. 13). Viable tumor cell clumps with normal mitoses were still
present in these tumors by 144 h, indicating that these tumors
would eventually regrow. Treatment with PG-TXL only resulted in a
mild increase in mitotically arrested cells and apoptotic cells,
presumably due to the small amount of free paclitaxel released from
PG-TXL (FIG. 13). By 96 h, tumors from PG-TXL-treated mice
developed extensive edema and necrosis, and only a small rim of
viable tumor cells remained. By 144 h, the residual tumor clumps as
compared to controls were comprised of cells that were larger, more
pleomorphic, and that displayed less mitotic activity.
These data suggest that the water-soluble PG-TXL conjugate of the
present disclosure has superior antitumor efficacy with reduced
toxicity as compared to conventional free paclitaxel preparations.
Although originally designed as a water-soluble form of paclitaxel,
it is now clear that the agent used to solubilize paclitaxel,
contributes to the overall anti-tumor activity of this remarkable
new complex. These data indicate that PG-TXL has an ability to
produce cell death in a manner which is separate from and in
addition to the apoptosis produced by released free paclitaxel.
EXAMPLE 8
Synthesis of Poly-Glutamic Acid-Camptothecin (PG-CPT) Conjugate
The synthesis of PG-CPT followed a similar reaction as previously
described for the synthesis of PG-TXL. Into 80 mg of PG polymer in
2.5 ml dry DMF was added 20 mg CPT (Hande Tech.), 34 mg DCC, and
trace amount of DMAP as catalyst. After stirred at room temperature
overnight, the reaction mixture was poured into chloroform, and the
precipitate collected. The dried precipitate was redissolved in
sodium carbonate solution, dialyzed against 0.05 M phosphate buffer
(pH 4.5), filtered, and lyophilized. The content of CPT in the
polymer conjugate was determined by fluorescence spectrometer
(Perkin-Elmer Model MPF-44A) using emission wavelength of 430 nm
and excitation wavelength of 370 nm. Content: 2% to 5% (w/w),
solubility: >200 mg conjugate/ml.
EXAMPLE 9
Synthesis of Poly-Lysine (PL) TXL Conjugate (PL-TXL)
All accessible amine functional groups of poly-lysine
(MW>30,000, Sigma) will be converted to carboxylic acid
functional groups by reacting poly-lysine with succinic anhydride,
glutaric anhydride, or DTPA. The remaining unreacted NH2 group in
polylysine will be blocked by reacting the modified polymer with
acetic anhydride. TXL, docetaxel, other taxiods, etopside,
teniposide, camptothecin, epothilone or other anti-tumor drugs will
be conjugated to the resulting polymer according to previously
described procedures for the synthesis of PG-TXL.
EXAMPLE 10
Synthesis of Other Polyamino Acids to be Used to Conjugate TXL
Polyamino acid copolymers containing glutamic acid may be
synthesized by the copolymerization of N-carboxyanhydrides (NCAs)
of corresponding amino acid with gamma-benzyl-L-glutamate NCA. The
resulting benzyl glutamate-containing copolymer will be converted
to glutamic acid-containing copolymer by removing the benzyl
protecting group (FIG. 15). TXL, docetaxel, other taxiods,
etopside, teniposide, camptothecin, epothilone or other anti-tumor
drugs will be conjugated to the resulting polymer according to
previously described procedures for the synthesis of PG-TXL and
PG-CPT.
EXAMPLE 11
Use of PG-TXL in Humans
Introduction
Poly-L-glutamic acid-Paclitaxel (PG-TXL) is a conjugate of
poly-L-glutamic acid and paclitaxel. This compound is water soluble
and based on early animal studies it appears that it can be
administered as a short, that is several minute, intravenous
injection. Based on the in vitro and early animal work, it appears
that this compound is at least as active against cancer as the
monomeric paclitaxel in Cremophor and may have fewer side effects.
Based on these observations, this drug will be studied in humans.
The study will first require formulation of this compound in a
solvent which is commonly used for intravenous infusion. The
inventors expect that either normal saline, 5% dextrose in water or
sterile water will be used as the solvent. This formulation of
PG-TXL will then be administered to at least two species of test
animals such as rats and dogs to determine the toxicities of the
drug in those animals and to determine a dose of the drug which
then can serve as the lowest starting dose for a Phase I human
study. That Phase I human study will define a dose of PG-TXL which
may be used in subsequent Phase II studies in patients. Phase II
studies will be performed in several tumor types to determine the
activity of PG-TXL in various cancers. One of ordinary skill in the
art will recognize that modifications in administration, selection
of animal models and dose regiments may be made in the methods
disclosed in following example, and such modifications are
encompassed by the invention.
Animal Studies
These studies will be performed in rats and Beagle dogs with
approximately 3 animals studied at each dose level of the drug. The
levels will be increased until life threatening toxicity is noted.
The animals will undergo blood testing as well as necropsy to
determine the organ systems which are susceptible to this drug's
toxicity and therefore to expect the side effects in human studies.
Once the dose is determined which causes the death of 10% of
animals then the equivalent of one-tenth of that dose will be
recommended as the starting dose for human studies. This is the
usual recommendation by the Food and Drug Administration (FDA) as
the initial dose for human Phase I studies.
Phase I Studies
Phase I study of this drug will be performed using the starting
dose defined in animal studies. The drug will be injected into the
vein by a syringe over several min or alternatively it may be
infused as a short infusion, up to approximately 10 to 15 min. The
volume of the solvent will be from 10 ml to approximately 100 ml
depending on which of the two intravenous injection approaches are
used. The drug will be administered every 3 wk. This schedule is
based on the early animal studies and on the schema used with
paclitaxel in Cremophor. Three patients will be started on the
lowest dose level as defined by the animal studies and will be
treated with an injection of PG-TXL. Blood tests will be performed
at baseline and weekly to evaluate blood counts; tests of liver
function and renal function will be performed every 3 wk. It is
expected that the counts and physiological parameters will recover
sufficiently from the PG-TXL to resume the next cycle of treatment
3 wk after the previous one. If this is the case then the treatment
will be repeated every 3 wk. If the first cohort of three patients
tolerates the drug for 3 wk then these patients will be allowed to
have the dose increased by a predetermined schema that is usually
used in the Phase I studies. Once three patients have tolerated the
first cycle, the next cohort of 3 patients will be started on the
next higher dose level. This process of increasing the dose level
will continue until at least 2 out of 3 patients at a dose level
have side effects which are so severe that they prohibit continuing
administration of the drug. In such a circumstance the dose level
just prior to the excessively toxic one will be considered the
level of drug to be administered in subsequent studies. Six to ten
patients shall be treated on the dose level which will be
recommended for Phase II studies to confirm its tolerability. Once
the appropriate dose has been defined and acute toxic side effects
of the drug evaluated, Phase II studies will be initiated.
Phase II Studies
Phase II studies of PG-TXL will be performed in several tumor
types. Each study will be designed in a usual standard Phase II
manner following either Gahan's or Simon's design. In brief,
approximately 14 patients of a given tumor type will be treated
initially, if there is no evidence of anti-cancer activity in that
tumor type then further studies of PG-TXL in that tumor type will
be aborted. However, if at least one patient has clinical benefit,
defined as at least 50% decrease in the sum of products of
perpendicular cross-sectional diameters of the tumors, then the
number of patients with that tumor type treated with PG-TXL will be
increased to 30. These studies will allow us to define the activity
of PG-TXL in various cancers and refine the information on the side
effects of the drug. The tumor types of special interest for PG-TXL
will be the ones which have shown good response to paclitaxel and
docetaxel. This will include ovarian cancer, breast cancer, and
lung cancer. Studies comparing poly-glutamic acid-paclitaxel to
paclitaxel in tumors showing response to PG-TXL will be performed.
Such studies are called Phase III studies.
Phase III Studies of PG Paclitaxel
Based on the activity of paclitaxel in ovarian cancer, breast
cancer, and lung cancer these will be the tumor types in which
PG-TXL will be compared to paclitaxel. In view of the necessity to
have a large number of patients in such randomized studies, the
inventors expect that a multi-institutional study will be
necessary. The inventors have in their institution access to
Cooperative Community Oncology Program (CDDP) and to many other
multi-institutional study groups. In addition to the potential
clinical benefit of PG-TXL vs. paclitaxel, it would be appropriate
to evaluate the economic impact of the two drugs. It is expected
that a short term infusion of PG-TXL may result in a less costly
treatment. And, therefore, there is an expectation that PG-TXL may
be cost effective relative to paclitaxel monotherapy. Not only is
the infusion going to be shorter, it is expected that in view of
the absence of Cremophor fewer side effects will be experienced by
the patients and therefore the premedication regiment including
steroids and intravenous H2 and H1 blockers may no longer be
necessary. All of these factors will result in a reduction in the
cost of the treatment.
SUMMARY
It is expected that the initial animal toxicology evaluation will
require up to 6 months. Subsequent to that, if a drug formulation
is available, human Phase I studies may be completed in another 6
to 9 months. Once these have been completed, Phase II studies in
various tumor types may take another 6 to 9 months. At that point,
the inventors will have a good idea of the efficacy of this drug
and targeted Phase III studies may be designed and initiated. It is
also possible that the Phase II studies will show enough clinical
activity that abbreviated Phase III studies or no Phase III studies
would be necessary.
While the compositions and methods of this invention have been
described in terms of preferred embodiments, it will be apparent to
those of skill in the art that variations may be applied to the
compositions, methods and in the steps or in the sequence of steps
of the methods described herein without departing from the concept,
spirit and scope of the invention. More specifically, it will be
apparent that certain agents which are both chemically and
physiologically related may be substituted for the agents described
herein while the same or similar results would be achieved. All
such similar substitutes and modifications apparent to those
skilled in the art are deemed to be within the spirit, scope and
concept of the invention as defined by the appended claims.
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